2. Self-funded employers. Self-insured employers are ripe for turning to ACOs to provide their care. In one East coast market, a self-funded employer is implementing the Medicare shared savings model for their employee health plan with a handful of health systems.
The employer's approach is novel. It projected spending on a per-capita basis and made an agreement with partnering health systems that if spending came in under the target in 2011, it would split the savings with them. There is no penalty for falling short of the target.
3. Health plans/insurers. Shared savings models are not exclusive to self-funded plans. Insurers are beginning to enter into these agreements with health systems as an insurance product. Several throughout the country already have been announced, including:
The rewards for meeting quality standards and cost reductions include bonus payments and shared savings to the provider network.
4. Medicaid. Community Care of North Carolina places a significant emphasis on medical homes, primary care, and disease management. Primary care physicians are paid fees for their services, plus a $3-5 management fee per member, per month for coordinating care.