At the 11th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference in Chicago on June 13, Thomas Dixon, associate director of provider strategy at Navigant Healthcare, spoke about accountable care organizations and why they matter for orthopedic- and spine-based ambulatory surgery centers.
ACOs are normally associated with larger hospitals, health systems and payers, but because healthcare is localized, smaller practices and organizations like ASCs may need to start asking themselves how they will fit into these accountable care structures. Mr. Dixon outlined five ACO options that providers are exploring right now and why they matter for ASCs today.
1. ACO affiliate network. In 2005, Mount Kisco (N.Y.) Medical Group became an ACO affiliate of Massachusetts General Hospital in Boston. The physician group wanted access to Massachusetts General's subspecialty services and branding recognition, and Mr. Dixon said ASCs could see other benefits in these types of arrangements, as well. "Developing relationships with ACOs gives you an opportunity to take advantage of price and cost advantages and grow volumes," he said.
2. Service line ACO. Health insurer Florida Blue and Baptist Health South Florida in Coral Gables launched a cancer ACO last year, and Mr. Dixon said orthopedic and spine ASCs have a lot in common with a cancer or service line ACO. "Both are multibillion dollar cost burdens in the United States. They are expensive treatments. And optimal care requires multidisciplinary collaboration," he said.
3. Clinically integrated network. Hospitals are increasingly looking to align ambulatory and physician-led networks because they see the maneuver as a competitive requirements, Mr. Dixon said.
4. Narrow network/payer relationship. ACOs may create a narrow network between the dominant health systems and payers. This matters for orthopedic- and spine-based ASCs, Mr. Dixon said, because as these narrow networks emerge, patient populations will shrink, and ASCs could lose revenue from being excluded from the network.
5. Super regional ACO. Naples, Fla.-based Health Management Associates and Florida recently created an ACO to serve patients in Brevard County, Fla., and Mr. Dixon said these super regional ACOs may pressure ASCs to focus more on value and scale — something they are not accustomed to as a "localized, fragmented ambulatory arena."
ACOs are normally associated with larger hospitals, health systems and payers, but because healthcare is localized, smaller practices and organizations like ASCs may need to start asking themselves how they will fit into these accountable care structures. Mr. Dixon outlined five ACO options that providers are exploring right now and why they matter for ASCs today.
1. ACO affiliate network. In 2005, Mount Kisco (N.Y.) Medical Group became an ACO affiliate of Massachusetts General Hospital in Boston. The physician group wanted access to Massachusetts General's subspecialty services and branding recognition, and Mr. Dixon said ASCs could see other benefits in these types of arrangements, as well. "Developing relationships with ACOs gives you an opportunity to take advantage of price and cost advantages and grow volumes," he said.
2. Service line ACO. Health insurer Florida Blue and Baptist Health South Florida in Coral Gables launched a cancer ACO last year, and Mr. Dixon said orthopedic and spine ASCs have a lot in common with a cancer or service line ACO. "Both are multibillion dollar cost burdens in the United States. They are expensive treatments. And optimal care requires multidisciplinary collaboration," he said.
3. Clinically integrated network. Hospitals are increasingly looking to align ambulatory and physician-led networks because they see the maneuver as a competitive requirements, Mr. Dixon said.
4. Narrow network/payer relationship. ACOs may create a narrow network between the dominant health systems and payers. This matters for orthopedic- and spine-based ASCs, Mr. Dixon said, because as these narrow networks emerge, patient populations will shrink, and ASCs could lose revenue from being excluded from the network.
5. Super regional ACO. Naples, Fla.-based Health Management Associates and Florida recently created an ACO to serve patients in Brevard County, Fla., and Mr. Dixon said these super regional ACOs may pressure ASCs to focus more on value and scale — something they are not accustomed to as a "localized, fragmented ambulatory arena."
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