The Centers for Medicare and Medicaid Services (CMS) revealed the next generation in the accountable care organization (ACO) concept this week, which will include more risk based on quality measures, and potentially, more reward.
The new model will use “predictable benchmark and flexible payment options that support ACO investments in care improvement infrastructure to provide high quality care to patients.” The model will aim to better enable ACOs to use innovative IT tools, such as telehealth through reimbursement, which enhance the management of care for beneficiaries.
News of this announcement was met with praise from industry observers. Blair Childs, senior vice president of public affairs at the Charlotte-based Premier healthcare alliance, said the latest model gives providers “even more choices, which will enable the market to both mature and evolve.” Russell Branzell, CEO of the Ann Arbor, Mich.-based College of Health Information Management Executives, had similar praise. Branzell spoke with Healthcare Informatics Senior Editor Gabriel Perna about the news. Below are excerpts from their interview.
What was your reaction to yesterday’s news regarding the new ACO payment model?
It’s not surprising. I know CMS is looking for ways to encourage innovation and to do it in a way that it encourages risk taking and some partnership in the care side of this. So, it’s not surprising because they’ve talked about doing this for some time. As a matter of fact, the Secretary [of Health and Human Services, Sylvia Mathews Burwell] talked about moving towards risk-based system. If you look at the natural progression that needs to occur from a fee-for-service to a managed care to a wellness model, this is that next logical step for them to try and encourage innovation. We’re not surprised, we’re pleased it will encourage telehealth, telemedicine and capture some of the benefits we’re seeing with IT utilization. It emphasizes we have a long way to go with IT, to get all the data needed to run these types of ACOs. We’re not sure what the big adoption will be, but the concept of cost sharing and cost benefit will encourage people to get more involved in their overall care and wellness.
What are you hearing from CIOs who are in the thick of these types of ACO initiatives?
I think CIOs have been at least trying to get caught up, if not trying to get ahead of this curve. That’s why the adoption cycle has been occurring at such a rapid pace over the last few years. I think that will continue and CIOs will guide their organizations as they take on these kinds of initiatives. I don’t think anything like this was a surprise to the C-Suite, in particular CIOs, especially for larger, more complex health systems, the integrated health systems, etc. Where I think this will be a pain point is with the smaller and medium organizations, that maybe aren’t as ready from not just a technological standpoint, but a maturity of their practice/hospital being ready to take on these models. Part of it this may be data oriented, because you need data to take on risk. The other part may be readiness for change in organization. This is change management; we’re talking cultural and behavioral change.
Telehealth is a big aspect of this proposed new model, what needs to happen to make it more widely adopted in accountable care and payment reform models?
One thing that really needs to happen, and we’re starting to finally see some movement on it, is payment reform for tele business. The technology has existed for probably a decade, maybe longer than that. This isn’t technology issue, as much as it’s a payment issue for physicians/caregivers/organizations to be able to do these kinds of visits. We’re starting to see change in that, we’re seeing stipulations in this, but we’re seeing collaboration across many of the states to enforce and encourage telemedicine and payment relative to telemedicine. The biggest challenge is to figure out what are the appropriate things to do via telemedicine, what are the environments physicians will thrive in a telemedicine environment. Is it an appropriate environment for care? If those match up for payment reform, I think we’ll see this take off to a high degree. And it saves time for everyone...especially for these smaller rural environments. This is a good next step to encourage telemedicine.
With this next generation ACO model, did CMS listen to some of the feedback given to them based on the first few models?
I think they did. I think there was risk with those pioneer early adopters that took off first. I still think there is a significant gap in individual accountability in this environment? How do you hold organizations and physicians accountable? And there is still that problem of how do you hold the individual accountable to both their behavior and change modification, their eating, their medication…so many things that are outside the control of those taking the risk on. That is something we’re going to have to address if we are going to see huge benefits to these ACO models. The technical background— the quality benchmarks, the requirements for data, the inclusion of telemedicine—some of that’s taken been taken into account. They’re still big item we haven’t dealt with, with individual accountability.
What needs to be done with getting that taken care of?
This is one I get baffled on. Is it relative to payment reform? Is coverage reform with insurance? Is it rebates with wellness? At some point, there needs to be something included in these models that address, some kind of link to the cost structure of these coverage programs, appropriate behavior or reward it. No one is doing it because it’s not easy to do. I’ve seen it through my physician in Colorado and I’ve seen it here… in Colorado, it was a physician collaborative and the one here is on a patient-centered medical home model, both are very proactive about [keeping patients accountable]. I’m interested to know how many are involved proactively in managing your care, because they’ll be held accountable from a financial and outcomes perspective.