Parke says a health plan could require members to comply with care coordination and case management to improve their health and help reduce costs. According to the proposed CMS rules, patients in ACOs can opt out of care coordination by refusing to share their personal medical information with all of the providers. But, they will still be counted as part of the ACO and thus will affect the quality points earned for financial incentives.
Why would a health plan want to be in a partnership? Parke says there is growing acceptance that integrated delivery systems are more cost effective and will allow a health plan to have more competitive premium rates.
Also, once the partnership is up and running, the health plan can delegate some of the administrative functions to the integrated delivery system. That will make it easier for the health plan to meets its surplus and profit goals under the Affordable Care Act.