ACOs Widespread, Yet Challenged

Joe Cantlupe, for HealthLeaders Media , June 18, 2013

"The ACO is much more diverse than any one of us expected," Fisher told the D.C. audience, noting there are "a lot of new partnerships, thanks to the kind of energy many of you are bringing to this."

Both McClellan and Fisher noted, however, that many organizations involved in ACO start-ups are trying to overcome challenges in implementing the programs, with concerns especially over lack of uniformity in performance measures sought by the government.

McClellan pointed out that those following the Pioneer ACO Model seek delays and modifications concerning quality metrics, "based on how the measures are calculated, the validity of measures" and, "in some cases, what's the right benchmark to use."

Fisher agreed that some data changes may have to be made. A major concern is variability in performance measures sought by the government in creating ACOs. "There are lots of challenges to ACO implementation. We've been hearing a lot about the need for a common set of performance measures, with everyone agreeing on the same set of measures," Fisher said.

There is a need to align emerging ACO programs with other initiatives, and "the challenge of engaging physicians who are completely stressed out in their current practices, to take the time to engage in a new model of thinking." Fisher noted that the provider side is "struggling to test new models and all of us are trying to learn new ways of practicing in partnerships that are more complicated."

Still, developing ACOs are showing early success in reducing costs, McClellan said. He pointed to ACOs involving Cigna and NovaHealth that have demonstrated dramatic savings in patient care.

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