Andrew Ziskind, MD, senior executive with Accenture, and Matthew Walsh, COO with Henry Ford Physician Network, recently spoke on accountable care organizations at Becker's 18th Annual ASC Conference in Chicago.
The conversation began with an overview of ACOs and what is driving their development. While ACOs are commonly hailed as revamped HMOs, Dr. Ziskind pointed out that we're in different landscape from the 1990s. "Costs have grown higher, something in Washington is pushing some of this and infrastructure like electronic medical records now allows us to manage information better. We didn't have that before," Dr. Ziskind said.
Commercial payors are driving the ACO market right now, although the recent release of the final Medicare ACO rule reduced the burden of a proposed rule that was vehemently disliked by providers. Still, commercial payors are assuming new roles in some markets, whether by selling their capabilities to providers, affiliating with providers to develop ACO projects, or actually making the move to become a delivery system, which is occurring in Pittsburgh with Highmark and West Penn Allegheny Health System.
Henry Ford began developing their ACO strategy in Jan. 2009 after employers in the region expressed interest in the model. "Our vision was to create a system that physicians wanted to practice in," said Mr. Walsh. The physicians grouped together to decide on metrics they felt were both measurable and valuable -- an initiative Mr. Walsh called a "pretty big effort," but one that didn't take too long to end in agreement.
Henry Ford's ACO is led by a 15-member, physician-led board that is balanced between medical group physicians, private practice physicians and ex-officio trustees. Mr. Walsh said the ACO is still facing a few challenges and working to accomplish specific goals in the next few years, such as integration with post-acute providers and how to move beyond FTC-validated clinical integration to achieve "true" clinical integration. While Henry Ford is open to ASC-integration, Mr. Walsh has said it has not yet had an opportunity to move down that avenue. It is still waiting for more data to fully evaluate cost-efficiency strengths and weaknesses.
Several members in the audience expressed concern that ACOs are biased to health systems, and do not leave much room for entrepreneurship, innovation or independent ASCs. While ACOs are looking to bend cost-curves with the most efficient providers, they might still be pressured to stick with hospital-owned facilities. This may just be a time-related issue, though, since ACOs are still in the early days of development. There is really no example of a "matured" ACO.
"As an ACO begins to emerge, it begins to serve patients with its own facilities," said Dr. Ziskind. For some markets, it may just depend what services a hospital has within the system. Still, Mr. Ziskind and Mr. Walsh recommended that ASCs avoid becoming isolated in their marketplaces. "I wouldn't wait for this to happen to you," said Dr. Ziskind. "I would get in on the dialogue."
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The conversation began with an overview of ACOs and what is driving their development. While ACOs are commonly hailed as revamped HMOs, Dr. Ziskind pointed out that we're in different landscape from the 1990s. "Costs have grown higher, something in Washington is pushing some of this and infrastructure like electronic medical records now allows us to manage information better. We didn't have that before," Dr. Ziskind said.
Commercial payors are driving the ACO market right now, although the recent release of the final Medicare ACO rule reduced the burden of a proposed rule that was vehemently disliked by providers. Still, commercial payors are assuming new roles in some markets, whether by selling their capabilities to providers, affiliating with providers to develop ACO projects, or actually making the move to become a delivery system, which is occurring in Pittsburgh with Highmark and West Penn Allegheny Health System.
Henry Ford began developing their ACO strategy in Jan. 2009 after employers in the region expressed interest in the model. "Our vision was to create a system that physicians wanted to practice in," said Mr. Walsh. The physicians grouped together to decide on metrics they felt were both measurable and valuable -- an initiative Mr. Walsh called a "pretty big effort," but one that didn't take too long to end in agreement.
Henry Ford's ACO is led by a 15-member, physician-led board that is balanced between medical group physicians, private practice physicians and ex-officio trustees. Mr. Walsh said the ACO is still facing a few challenges and working to accomplish specific goals in the next few years, such as integration with post-acute providers and how to move beyond FTC-validated clinical integration to achieve "true" clinical integration. While Henry Ford is open to ASC-integration, Mr. Walsh has said it has not yet had an opportunity to move down that avenue. It is still waiting for more data to fully evaluate cost-efficiency strengths and weaknesses.
Several members in the audience expressed concern that ACOs are biased to health systems, and do not leave much room for entrepreneurship, innovation or independent ASCs. While ACOs are looking to bend cost-curves with the most efficient providers, they might still be pressured to stick with hospital-owned facilities. This may just be a time-related issue, though, since ACOs are still in the early days of development. There is really no example of a "matured" ACO.
"As an ACO begins to emerge, it begins to serve patients with its own facilities," said Dr. Ziskind. For some markets, it may just depend what services a hospital has within the system. Still, Mr. Ziskind and Mr. Walsh recommended that ASCs avoid becoming isolated in their marketplaces. "I wouldn't wait for this to happen to you," said Dr. Ziskind. "I would get in on the dialogue."
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