ACO Update: Health Affairs Releases a Policy Brief

On January 31, 2012, Health Affairs, a peer-reviewed monthly journal, released a six page Health Policy Brief providing an update of where the US healthcare industry is in its rapid evolution towards accountable care type organizations.

The .pdf of the policy brief can be downloaded here.

The value of this paper is not limited to just the historical overview provided. The authors also give a general overview of some of the ongoing issues of the ACO model (small savings, anti-trust issues, enrollment, etc...).

Readers looking to for deep technical details of ACOs will be disappointed with this paper. However, those looking for a general overview of the current status of the ACO evolution will find this paper informative.

CMS Approves ACO for Central Indiana

Yesterday, CMS announced that 32 applications for Pioneer ACO from health systems across the country have been approved. The Franciscan Alliance was approved for the Indianapolis and Central Indiana region.

The press release from the Franciscan Alliance can be found here: http://stfrancisnews.blogspot.com/2011/12/franciscan-alliance-selected-to.html

The press release fact sheet from CMS announcing the 32 Pioneer ACOs can be found here: http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4225

Over the past several months, the concept and model of an ACO has changed several times. This announcement is specifically for the Pioneer ACO model. Applications for the Advanced Payment Model is not due to CMS until Jan 2012.

This link will take you to a general resource about the Pioneer ACO Model: http://innovations.cms.gov/initiatives/aco/pioneer/

This link will take you to a general resource about the Advanced Payment ACO Model: http://innovations.cms.gov/initiatives/aco/advance-payment/

The most recent final rules from CMS concerning ACOs was published Oct 20, 2011. That document can be downloaded here: http://www.gpo.gov/fdsys/pkg/FR-2011-11-02/pdf/2011-27461.pdf

Healthcare quality professionals will be most interested in the list of 33 quality measures that will impact payments to ACOs.  That list is on page 67889, or the 88th page into this above document.

ACOs are here! ...but will it be everywhere?

Details of the long awaited CMS ACO proposed rules were released on March 31, 2011 and posted in the April 7, 2011 edition of the Federal Register.

The Federal Register entry can be found here.

The Centers for Medicare and Medicaid Services also simultaneously posted fact sheets and other resources about the proposed ACOs rules:

• Summary of Proposed Rules.
• Summary of the 65 ACO Performance Measures
• Other Federal Agencies Addressing the Legal Issues of ACO Participation
• The Press Release Announcing the ACO Rules
• CMS Fact Sheet about what Providers Need to Know of ACOs

No doubt there will be significant commentary provided by healthcare organizations throughout the country over the next few months. The comment period closes on June 6, 2011. ACO final rules go into effect January 1, 2012.

FAQ on ACOs

Discussions of Accountable Care Organizations (ACOs) are sure to dominate the minds of hospital and health plan administrators in the next few months/years. The establishment of these entities will likely impact the work and expectations of health care quality professionals. Kaiser Health News recently posted an ACO FAQ list. You can find it here.

This FAQ provides thoughts to the following questions:

• What is an accountable care organization?
• When will ACOs begin operating?
• Why did Congress include ACOs in the law?
• How would ACOs be paid?
• How will an ACO be different for patients?
• Who's in charge — hospitals, doctors or insurers?
• If I don't like HMOs, why should I consider an ACO?
• What can go wrong?
• Are there any possible legal concerns?