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ACO

Legal & Regulatory

Survey: Hospitals ill-prepared for financial risk

Few hospitals interested in becoming ACOs are ready to take on financial risk, according to a Commonwealth Fund survey of nearly 1,700 hospitals. ACOs are pursuing models that let them share in any savings they achieve, without losing money if they fail to cut costs. This is likely to continue: Only one in five indicated they were using data to predict which patients are most likely to be in poor health and need more services--a significant gap in their ability to manage risk, lead author Anne-Marie Audet tells Kaiser Health News. (Kaiser Health NewsCommonwealth Fund issue brief)

 

 

MU, HIPAA are intentionally intertwined

One of the most significant aspects of the Meaningful Use final rules is how intertwined they are with HIPAA's privacy and security requirements, FierceEMR reports. Keeping electronic records secure--and allaying patient fears about security--are high priorities. "We're reinforcing HIPAA," Elizabeth Holland, director, HIT Initiative Group of CMS' Office of e-Health Standards and Services, tells FierceEMR. "We're emphasizing the privacy and security of patient information. People are wary [about the confidentiality of their records] when the information goes electronic." (FierceEMR)

 

 

Hospitals dealing with poor aren't doomed to high readmits

More than 2,000 hospitals will face readmission penalties, Kaiser Health News reports. Together, they will forfeit about $280 million in Medicare funds over the next year. Kaiser Health News' analysis of the records reveals hospitals that treat the most low-income patients will be hit especially hard. However, CMS points out some hospitals with the most-impoverished patients, such as Denver Health, do avoid excessive readmissions. "We do not want to hold hospitals to different standards for the outcomes of their patients of low socioeconomic status," the agency noted. (Kaiser Health News)  

    

Industry News 

Survey finds agreement on value of health IT

A KPMG survey of providers, health insurers and pharmaceutical companies finds all view health IT as crucial to health care transformation. Payers see value in health IT; 44 percent said it could be effective in holding down costs. By comparison, 32 percent of the health plans said that about pay for performance and 22 percent about ACOs. KPMG believes data analytics will be central to the coming transformation--especially under a scenario in which there's rapid integration of health care systems and between providers and payers, Information Week reports. (Information Week; KPMG survey)

 

Patient choice, FFS key issues for ACOs

ACOs have two obstacles to overcome, John McCracken, PhD, writes: fee-for-service payments and patient choice. The first will likely be overcome, and when that happens, "the adjustment period for providers is likely to be shorter and more traumatic than they now envision." The second is trickier, but must be done if ACOs are to become truly responsible for the health outcomes of a defined population. (Alliance for Medical Management Education blog)

   

   

Cigna recently announced several new ACO ventures. They include agreements with Martin's Point Health Care and Mercy Health System in Maine; Ohio's Mount Carmel Health Partners; New West Physicians in Denver; Palo Alto (Calif.) Medical Foundation; Burlington, Vt.-based Fletcher Allen Health Care and Central Vermont Medical Center in Berlin; and Texas' St. Luke's Health System Clinically Integrated Providers and Renaissance Physician Organization. (Becker's Hospital Review; Advisory Board Daily Briefing; Modern Physician) 


Provider Connections  

Just released: PCMH improves outcomes, enhances experience, controls costs

The patient-centered medical home improves health outcomes; enhances the patient and provider experience of care; and reduces expensive, unnecessary hospital and emergency department utilization. In short, it accomplishes the three-part goal of better health outcomes, better care and lower costs. So concludes a new report from the Patient-Centered Primary Care Collaborative, sponsored by the Milbank Memorial Fund. The report, released today, also finds that medical home expansion has reached the "tipping point," because of broad private and public sector support.Health2 Resources served as developmental editor for the project. (Benefits of Implementing the Primary Care Patient-Centered Medical Home: A Review of Cost & Quality Results, 2012.)


BlueCross to launch its first Tenn. ACO

Methodist Le Bonheur Healthcare and BlueCross BlueShield of Tennessee are set to launch a new accountable care organization on Jan. 1, 2013, according to BlueCross. The partnership represents BlueCross' first ACO in Tennessee, Memphis Business Journal reports. (Memphis Business Journal) 

 

 

Blue Shield of California to launch eighth ACO

Blue Shield of California plans to collaborate with Dominican Hospital in Santa Cruz and Physicians Medical Group of Santa Cruz County to form the insurer's eighth ACO. The ACO will cover about 8,000 Blue Shield beneficiaries and seek to maintain flat health costs in the first year (Modern Healthcare)

 

Innovators
AHIP, Colorado Beacon focus on payment reform

Among the speakers at AHIP's Summit on Payment Reform and Delivery Transformation Sept. 11-12 in Washington is Patrick Gordon of Rocky Mountain Health Plans (RMHP) and Colorado Beacon Consortium, who will talk about "Medicaid and Community-based Payment Reform Collaboratives." He is in an especially strong position to discuss reforms in the context of Medicaid: RMHP is part of a payment reform initiative that seeks to create a sustainable, non-fee-for-service payment model to integrate behavioral health and primary care. Details are available in a new issue brief. (WTHR; CBC issue brief: Tear down this wall: Rocky Mountain Health Plans embarks on a mission to bring together behavioral health and primary care)

 

  

Boston Children's takes "Moneyball" approach

Boston Children's Hospital has saved $1.4 million in the past year by using informatics for its medication delivery system. The hospital's informatics department also uses informatics to electronically document physicians' notes, provide patients' ID bracelets that link to their EHRs and contribute to population studies. The Boston Herald compares the approach to that used in Moneyball: "Like characters Billy Beane and Peter Brand in Moneyball," Dr. Daniel Nigrin and statistics whiz Dr. Jonathan Bickel "analyze patient data to improve clinical performance." (Boston Herald--subscription required; Advisory Board Daily Briefing)

 

 

Consultant: Start with employee ACOs

Nathan Kaufman of Kaufman Strategic Advisors suggests targeting health system employees rather than the Medicare population in ACO implementation. "The empirical evidence suggests that a Medicare ACO is not the place to start developing these necessary competencies," he writes in Hospitals & Health Networks. By starting with an ACO for its own employees, a health system should build its competencies in an environment with limited external bureaucracy and "where it can reap the financial benefits of every dollar saved." (Hospitals & Health Networks)



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PCMH Multi-media 

Methodist's McNutt talks about Meaningful Use

CIOs are pushing their hospitals along the IT adoption curve. In this H&HN Daily video, Methodist Health System's Pamela McNutt discusses the challenges of meeting Meaningful Use and the growing importance of data to improve care. (H&HN Daily

 

MarketVoices...quotes worth reading   

  

"We must implement better ways to care for our most vulnerable citizens--and to pay for that care. Good intentions are not enough. No one-not the patients, the providers, employers, payers or taxpayers-is served by piecemeal approaches. We must create and put into place models that are sustainable over the long term." --  Patrick Gordon, director of government programs for Rocky Mountain Health Plans and Colorado Beacon Consortium program director, in a prepared statement quoted on the WTHR website.

 
   
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Thursday, Sept. 6, 2012

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