Accountable Care Organizations (ACOs)

A number of San Francisco area providers and Health Net of California, a Woodland Hills-based payer, are forming an accountable care organization (ACO) for University of California (UC) employees living or working in the area. The hospitals joining in this initiative are the University of California at San Francisco (UCSF) Medical Center, UCSF Benioff Children’s Hospital, San Ramon, Calif.-based Hill Physicians Medical Group, and St. Mary’s Medical Center and Saint Francis Memorial Hospital both of San Francisco.

Changes in the industry landscape are forcing health plan leaders to reevaluate their value proposition while continuing to execute effectively on these core competencies. There is additional pressure on health plans to now be the engine that seamlessly powers the all-important patient-provider relationship. This is the perfect time for a health plan to embark on a transformation of its core service model, thereby putting itself in a position to capitalize on the service expectations associated with the changing industry landscape.

As hospitals, physicians and insurers deal with shifting reimbursement scenarios and IT investment demands, a recent Black Book Rankings (Clearwater, Fl.) survey reveals that 96 percent of organization executives are in the active acquisition process of several crucial ACO data solutions. Based on the uncertainty of their current system capabilities to meet reimbursement complexities, 88 percent of ACO leaders indicated they intend to seek external advisement from consultants and vendors to identify ACO provider technology needs and make system selections.

The National Quality Forum (NQF) has endorsed 12 quality measures, promoting effective patient-centered care and effective communication in relation to the disparities and cultural competency of meeting the needs of a diverse patient population. Seven of the measures came from an American Medical Association (AMA) resource, called the “Communication Climate Assessment Toolkit.”

On August 7, the Charlotte-based Premier health alliance launched a new collaborative to help health systems apply for the Medicare Shared Savings Program (MSSP), which, as authorized under the Affordable Care Act, established accountable care organizations (ACOs) as vehicles for care coordination and hospital-physician collaboration through new reimbursement arrangements under the Medicare program.