ACO Blueprints: Options in Accountability

Margaret Dick Tocknell, for HealthLeaders Media , May 14, 2012
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Are ACOs Too Good To Be True?
Accountable care organizations certainly aren't a panacea for poorly run organizations, and even well-oiled ACO machines encounter difficulties.

Wheeler says that while the collaboration between Allina and HealthPartners hasn't been a problem, the Northwest Metro Alliance has faced other challenges common to coordinated care efforts:

  • Lack of timely claims data. The alliance works with adjudicated claims, but there is typically a two- to three-quarter delay in receiving the information. The group keeps its own quality measures but needs timely claims data so it can assess outcomes in terms of cost efficiency and quality improvement. Wheeler says the alliance is working to receive some feeds on commercial claims that are pre-adjudicated, meaning they aren't completely settled up. CMS has agreed to provide monthly feeds of adjudicated Medicare claims.
  • Overwhelmed physicians and medical staff. Wheeler explains that much of the care savings achieved by the alliance involves providing patient care in different ways. That means getting the clinical involvement of the providers who know the patient best. "But they are often loaded up with patient care and improvement initiatives of their own, so we have to try and sync those things up to make sure we aren't overtaxing them." She notes that within the Allina system alone, providers are responsible for more than 700 quality measures requirements from regulatory agencies and different commercial payer arrangements.
  • Migratory nature of health plan members. Wheeler would like to work with the same patients throughout the collaboration, but the reality is that health plan members come and go, so it's impossible to develop perfect cost or quality comparisons from year to year.

She says entering into an ACO-like strategy allows providers to really look at and understand all of their clinical practice patterns. It puts a focus on developing efficiencies and improvements around staff, work flow, and clinical performance—all to the benefit of patients.

Still, she cautions that "there's no quick fix to the total cost of care, so things like collaboration and joint commitment to the mission become even more important and take time."

This article appears in the May 2012 issue of HealthLeaders magazine.

Reprint HLR0512-2


Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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