Healthcare Benchmarks and Metrics May 2015
www.hin.comThe Healthcare Intelligence Network • 800 State Highway 71, Suite 2 • Sea Girt, NJ 08750
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Accountable Care Organizations in 2015:
One-Fifth Primed for ‘Next Generation ACO’ Participation
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May 2015 • Accountable Care Organizations in 2015
Accountable Care Organizations in 2015: One-Fifth Primed for ‘Next Generation’ ACO Model
It’s an auspicious era for accountable care organizations: even before CMS’s announced agenda for moving Medicare into value-based payment models like the ACO, the number of public and private ACOs topped 700, by a Leavitt Partners estimate. And now, one-fifth of healthcare organizations are gearing up to participate in CMS’s new ‘Next Generation’ ACO model in the year ahead, according to 2015 metrics from the Healthcare Intelligence Network (HIN).
In the Next Generation ACO model, participants can take on greater financial risk than those in current Medicare ACO initiatives, while also potentially sharing in a greater portion of savings. Next Generation ACOs will have a stable, predictable benchmark and flexible payment options that support ACO investments in care improvement infrastructure to provide high quality care to patients, CMS said in announcing the model earlier this year.
About a third of future Next Generation ACOs identified in HIN’s fourth comprehensive ACO snapshot are administered by physician-hospital organizations (PHOs), with more than half staffed with between 100 and 500 physicians.
Seventy percent of respondents to HIN’s ACO survey already participate in CMS’s Medicare Shared Savings Program (MSSP), while almost 10 percent have committed to the federal payor’s Advance Payment ACO, an innovative model designed for small physician practices or hospitals and doctors that work in remote rural areas.
The industry’s slow shift to value-based reimbursement is reflected in respondents’ favored payment model. Forty-five percent report a hybrid formula: fee for service plus care coordination plus shared savings.
Survey Highlights
�� Fifty-four percent expect CMS to attain its goal of shifting half of Medicare provider payments to value-based payment models by 2018.
�� Data analytics pose the greatest challenge to ACO operations, say one-third of respondents.
�� Clinical outcomes are the ultimate measure of ACO success, say 80 percent of organizations surveyed.
�� Two-thirds of respondents credit improvements in care coordination to its ACO activity.
�� One-quarter of respondents will launch a new accountable care organization in the next twelve months.
Buy the Complete ReportNeed more data from this survey? The Healthcare Intelligence Network has produced 2015 Healthcare Benchmarks: Accountable Care Organizations, a 60-page resource capturing ACO adoption, growth, tools, impacts, results, ROI, and much more.For more information on this report, please visit: http://store.hin.com/product.asp?itemid=5046
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May 2015 • Accountable Care Organizations in 2015
Program Components
�� Forty-four percent of respondents belong to private insurer ACOs, while 9 percent of respondents participate in Medicaid ACOs.
�� Telehealth is offered by 34 percent of responding accountable care organizations.
�� Twenty-three percent of responding ACOs are administered by physicians only.
�� Thirty-seven percent of surveyed ACOs include home health providers.
�� More than a quarter of respondents—27 percent—include the dually eligible among populations served by their ACO.
�� Three-quarters of responding ACOs are invested in population health management.
�� Forty-two percent of future ACOs will be administered by an independent entity.
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May 2015 • Accountable Care Organizations in 2015
Results and ROI
�� Sixteen percent of respondents estimate their ACO has achieved ROI of between 2:1 and 3:1.
�� Beyond clinical outcomes, patient satisfaction and overall operating costs are measures most indicative of ACO success, say 68 percent of respondents.
�� Fifty-nine percent of respondents say hospital admissions have declined as a result of accountable care.
Successful Workflows, Tools and StrategiesHere is a sampling of ACO approaches by survey respondents that generate results:
�� “Team approach surrounding each patient and involving only the key necessary players as appropriate.”
�� “‘Home to Stay’ care transition program and protocol.”�� “Immediate follow-up after hospitalization in PCP office.”�� “Sharing best practices on care management and care coordination.”�� “Our EMR, patient portal, and care coordination efforts.”
About the SurveyThe 2015 Accountable Care Organization survey was administered in April 2015 via the Healthcare Intelligence Network Web site at http://www.hin.com. Respondents were invited to take the survey via e-mail, e-newsletter and social networking reminders throughout the month. A total of 116 healthcare companies answered the survey, which asked 32 questions on current and planned ACO activity, with multiple responses possible on some questions. Some questions were open-ended, inviting write-in responses. Not all surveys were fully completed. Data is qualitative, with results compiled by the Healthcare Intelligence Network.
Respondent Demographics
Responses to the April 2015 survey on accountable care organizations were submitted by 110 organizations. Of 65 respondents identifying their organization type, 30 percent were consultants, 11 percent were hospitals or health systems, 9 percent were health plans, 6 percent identified as either physician-hospital organizations (PHO), primary care physicians or multi-specialty practices, and 18 percent categorized their organization type as ‘Other.’
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May 2015 • Accountable Care Organizations in 2015
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About the Healthcare Intelligence NetworkThe Healthcare Intelligence Network (HIN) curates high-quality information on the business of healthcare. Healthcare executives can receive exclusive, customized real-time news and data in their preferred format in five key areas: healthcare and managed care, hospital and health system management, health law and regulation, behavioral healthcare and long-term care.
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Option 1: Buy the Full ReportDownload the PDF instantly ($127) or order a print copy ($142) of 2015 Healthcare Benchmarks: Accountable Care Organizations, a 60-page resource capturing ACO adoption, growth, tools, impacts, results, ROI, and much more. For more information on this report, please visit: http://store.hin.com/product.asp?itemid=5046
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