ACOs in Massachusetts: An Update

As I have said frequently, tracking the latest developments in Massachusetts is very likely a good bell weather on how how health care reform will play out in the rest of the country. Here is the latest from the medical director of Health Integrated on his company's plans to become an ACO in the next five years:

The strategic plan includes centralization of the full range of medical services. This goal was to be accomplished by:

• Increasing provider accountability and consumer education
• Rewarding physicians for delivering high quality care
• Providing incentives for efficient, appropriate care
• Structuring the care continuum to align incentives for all participants
• Integrating existing CHA ACO elements

In order to drive this kind of change, a new payment model was required. This new model had several priorities regarding payment and incentives, many of which are aligned with our previous discussions concerning successful ACOs. These have included:

• Alignment of all stakeholder financial interests including improved outcomes in patient health and expenses
• Creation of a global payment structure
• Preparation to accommodate an all-payor system

The development of strategic partnerships will be important. These could be with other private payors, like NH for example. Massachusetts has already adopted and implemented this innovative healthcare reform model. In doing so, they are leading the nation in healthcare reform. As you may have also experienced, consolidation of the industry is already beginning and relationships with providers, particularly the tertiary care institutions in the state, are necessary. Additionally, the development of select provider networks is desirable and possible. As the state of Massachusetts is already moving toward global payments, this must continue to be a priority.

Within the managed care plan, Network Health brings specific competencies to the partnership including:

• Data
• Care management
• Cultural transformation support
• Existing provider network

The Patient Centered Medical Home (PCMH), is expected to be a strategic tool for both care delivery and effectiveness. The PCMH is expected to be the vehicle to accomplish many tasks including the improvement in:

• Preventive care
• Primary care
• Care coordination and management
• Access
• Patient/care team relationships
• Patient experience
• Consumer involvement
• Identification and management of high risk populations
• Payment structures

In conclusion, Dr. Yeracaris summarizes that although the journey to becoming a high-performance ACO is complex, health plans, specifically those that are provider-sponsored can play an important role in assisting providers with the transition. It is encouraging to see that global payment arrangements and primary care medical homes offer significant theoretical opportunities to improve care and truly “bend the cost curve”, but the thesis has yet to be proven.

On a closing note, it should be noted that the prediction of 5 yrs. for the complete formation of this ACO shows how difficult and complex this task is and makes one wonder if their formation will take as long in other parts of the country.