Innovaccer Inc. Inaugurates New ACO Initiative to Help IPAs & Providers Transition

Innovaccer Inc., a Silicon Valley-based Healthcare analytics company has started a ‘no cost’ initiative to give assistance to Independent Physician Associations (IPAs) and other transforming provider agencies to transition into an Accountable Care Organization (ACOs)

The idea of value has become notable in the advancing healthcare. Care teams are developing room for improvement in care delivery to bring down the cost of care with a better quality of care. The complexity and competition linked with value-based reimbursement need IPAs and other provider agencies to remain flexible with strategically transforming healthcare.

Innovaccer Inc. will give a consultation on the complete roadmap encompassing:

– Participation options: ACOs can apply to engage in various Shared Savings Program tracks. As per the current situation and future aims, Innovaccer Inc. will assist provider organization to identify the most suitable option for themselves.

– Eligibility Criteria: Detailed information on all the clauses that is essential to be fulfilled to become an ACO.

– Health IT backbone: The type of IT backbone needed to assist the ACO succeeds and the investment needed to develop such IT infrastructure.

– Delivering and maintaining the quality of care: Value-Based performance analytics needed to track all payer contracts by quality and cost measures to recognize improvement opportunities and beat benchmarks.

– Expense control and Network utilization: Comprehending what are the huge cost drivers to identify leakages, manage costs in the network across all regions, facilities, and providers and increase network utilization.

“We’ve been working with IPA and ACO customers for a while now and have been delivering increasingly better clinical outcomes for them. We are happy to extend our resources and technical acumen to IPAs and other growing provider agencies to tackle the sharp learning curve to becoming a victorious ACO, with every requirement of this transition – right from understanding eligibility criteria and participation choices to improving physician communication and quality of care,” claims Abhinav Shashank, Co-founder and CEO at Innovaccer.

Innovaccer was recently elected by Mercy ACO, one of the largest value-focused agencies in the Mid-west as the technology partner to deliver value-based care. Innovaccer has also worked with several other key IPAs and ACOs towards improving clinical and financial outcomes, helped by Datashop – Innovaccer’s proprietary end-to-end value-based care solution.

 

Care management program decreased healthcare charges in Pioneer ACO

Healthcare is going through a major transformation both in how care is delivered and how it is paid for across the country. These alternative payment models, like Accountable Care Organization (ACO) of Medicare, need health care delivery agencies to share in the financial risk linked with their patients' medical spending and motivate health care providers to think of alternative ways to get sufferers the care that they require. However ACOs seem to lower medical spending, there is less information on how these savings are really acquired. Today, researchers at Partners HealthCare published a study demonstrating that Partners Pioneer ACO not only decreases spending growth, but does this by reducing avoidable hospitalizations for sufferers with elevated but modifiable risks. The research appears in the month of May issue of the journal Health Affairs. Care management program reduced healthcare charges in Partners Pioneer ACO.

The research analyzed the impact of patient participation in the Pioneer ACO and its care management program on rates of emergency department (ED) visits, hospitalizations’ rates, and on overall Medicare spending. To measure the effect of ACO, and separately the care management effect, the researchers compared participation in the care management program to a similar group of sufferers who were eligible but hadn’t yet initiated the care management program.

"The significant finding was that the care management program seemed to be the mechanism through which the ACO was capable to acquire its benefits," stated John Hsu, MD, the study's first author and Director of Clinical Economics and Policy Analysis Program at the Mongan Institute for Health Policy at Massachusetts General Hospital, which is key part of Partners HealthCare. Sufferers in the care management program had lower rates of emergency department visits (94 percent of the rates of non-participants) and non-emergency visits (88 percent of the rates of non-participants), and an 8 percent decrease in hospitalizations. The longer the sufferer was in the program, the higher the reduction in hospitalizations.

"The decrease in utilization and spending are modest, but grow with sufferer participation in the program," claimed Eric Weil, MD, Chief Medical Officer of Primary Care in the Center for Population Health at Partners HealthCare, and one of the study authors. "The outcomes of the study recommend that focusing on sufferers with high risk is a key strategy and might explain the decrease in spending growth linked with ACOs."

In terms of cost savings, participation in the care management program was linked with a reduction in Medicare spending of $101 per participant each month, a decline of 6 percent. The whole ACO population, similar to comparable studies, reduced health care spending $14 each participant per month, a 2 percent decline.

"However the impacts of payment system changes are yet ongoing, this research reinforces the observation that altering care delivery takes time, but is worth the investment," stated Gregg Meyer, MD, Chief Clinical Officer at Partners HealthCare.

The care management program concentrates on chronically ill sufferers with several health problems, like diabetes, heart failure, and depression. Started at Massachusetts General Hospital in the year of 2006 as part of the Medicare Care Management for High Cost Beneficiaries Demonstration, the program now treats and handles the care for more than 12,000 complex, high risks adult and pediatric patients cared for at every Partners HealthCare primary care practice.

Sufferers are offered services by nurse care managers who work with physicians in the primary care office of patient. They establish custom treatment plans that deal any gaps in health care or social factors, like isolation and deficiency of family support. The care manager becomes the central, consistent point of contact for the sufferer. Other members of the care team involve social workers, community resources specialists, a pharmacist, and the patient's specialists. The care management group works with sufferers and their families in several settings involving the primary care office, at home, in the hospital, and in the emergency room (ER).

"The research indicates how one successful ACO was capable to acquire benefits, involving expansion from one hospital to the whole delivery system," stated Dr. Hsu. "This information can assist other health systems in the US as they contemplate entry into alternative payment models or make investment decisions to increase an existing ACO."

 

Innovista Health Solutions announces new partnership with Seven Flags ACO

Innovista Health Solutions (Innovista) has declared a new client partnership with Seven Flags ACO (Accountable Care Organization). Seven Flags ACO was started in the year of 2016 with eighteen Primary Care Physicians, committed to giving high quality, cost effective care to their sufferers. With the addition of various El Paso Physicians in 2017, the ACO will handle over 10,500 patients in value based contracts.

Seven Flags ACO is comprised of 2 U.S. Mexico border regions which are featured by having difficult sufferer populations to manage because of the inequitable access to health care. The physicians partnering in this ACO have a chance to combat these community challenges and make better access to quality care.

This Seven Flags ACO is believed to be one of several new ACOs developed through the collaboration of Innovista and TMA PracticeEdge. TMA PracticeEdge, LLC, is a services company established by the Texas Medical Association to bring physicians the technology and expertise they require taking advantage of new health care payment models. To date, ten ACOs have been launched as an outcome of this thriving partnership. Seven Flags Accountable Care Organization joins Innovista's growing Texas market of independent provider organizations, which involves more than 1,000 physicians providing care throughout Texas communities.

"We’re excited to combine our individuals and management processes with Seven Flags' passionate commitment of giving high quality, value-based care. Together, I feel confident we will see great results in this new ACO," said Rich Steinle, CEO of Innovista Health Solutions.

"Partnering with TMA PracticeEdge and Innovista has permitted the Laredo community to develop a thriving ACO that welcomes physicians who’re committed to improving overall patient care. Our hopes are to sustain to grow the Seven Flags ACO with the addition of new value based contracts and physicians," claimed Dr. Luis Benavides, President of Seven Flags ACO.

Texas ACO Produces $14M in Savings, Acquires Perfect Quality Score

Rio Grande Valley Health Alliance, LLC (RGVHA), a Texas ACO (accountable care organization) based in the region of McAllen, Texas, is acquiring important cost savings and quality improvements spearheaded by area primary care physicians who’ve joined hands with population health technology provider Lightbeam Health Solutions.

The Texas ACO contains 18 primary care physician practices working with the Centers for Medicare & Medicaid Services (CMS) to give coordinated care to Medicare sufferers in the Rio Grande Valley of South Texas. Since it started operating as an ACO in the year of 2013, RGVHA has saved more than $28 million – almost $14 million in the year of 2015 alone – by better stratifying and serving its population with tools from Lightbeam.

“Lightbeam’s value to our ACO goes beyond population health software because we benefit merely as much from Lightbeam’s information and best practices for orchestrating proactive and efficient work by physicians and care management teams. Lightbeam assists us stay a step ahead of our populations’ health requirements, which lets us deliver both quality and cost savings that we are very proud of,” stated Victoria Farias, assistant administrator at Rio Grande Valley Health Alliance, LLC. “We sustain collaborating with Lightbeam to recognize and deal new ways of cost-effectively providing high-quality care, especially for those patients with the most acute and chronic conditions.”

In the latest ACO Financial Report from CMS profiling results from the 2015 Medicare Shared Savings Program (MSSP), RGVHA was also one of mere four ACOs in the nationwide program to acquire a perfect 100% quality score. These outcomes were because of the ACO working with a scorecard system based on Lightbeam quality measures that also targeted non-compliant patients so care teams could more proactively handle those individuals’ care.

“We are proud to join hands with Rio Grande Valley Health Alliance to find ways to decrease healthcare charges while identifying sufferers whose lives can be improved simply through heightened healthcare education and more proactive care coordination,” claimed Pat Cline, CEO of Lightbeam. “The Lightbeam platform assists ACOs such as Rio Grande risk-stratify their populations to a granular level and our tools deliver that reliable information to care teams that use it to move more rapidly and decisively to close care gaps, increase patient engagement and decrease cost. We consider that Rio Grande is an outstanding blueprint for other ACOs looking to deliver similar savings and quality scores.”

Key points of the victory of RGVHA Texas ACO involve:

• Reducing home health spending by 41%


• Viewing sufferers’ underlying data, comparing it to CMS home health criteria, and recognizing patients who qualify for alternative avenues of care


• Decreasing emergency room visits and associated hospitalizations by 10%


• Improving care coordination across the health system and connecting area providers to better handle several patient populations

A significant next step for the ACO is deploying the Lightbeam Cohort Builder to assist RGVHA further identify high-risk sufferers who can enroll in several evidence-based care programs to make better patient outcomes and lower costs. Cohort analysis assists ACOs and providers by offering clear guidance and prioritizing where care management and other attempts should be focused.

 

The Worth of chiropractic patients with ACOs

Together with the other providers, Chiropractors and chiropractic patients can work with Accountable Care Organizations. These groups of primary medical care experts give coordinated care for Medicare sufferers. Accountable Care Organizations (ACOs) are created to make Medicare more effective by instructing patients to get the right services.

As an outcome, the aim is to decrease medical flaws and unessential services. When the Medicare program saves and secures funding from these programs, a portion of the savings are passed on as an incentive for ACO providers.

For chiropractors and chiropractic patients who are fascinated in working with ACOs, this depicts a chance to generate extra revenue while also making better the care of Medicare sufferers. Medical providers aren’t needed to engage in an ACO, although Medicare motivates participation and provides incentives to do so.

Primary care is the significant focus of this program, so specialty care providers aren’t eligible. Chiropractors might not register individually as ACOs, but they are eligible to work with other kinds of providers like MDs or DOs who made an ACO as a group.

Medicare shared savings program

This program permits Medicare providers to make new ACOs. During the yearly or annual application time period, Medicare accepts latest ACO applicants to the Shared Savings Program. Generally, applications are accepted early in the year for participation that starts the following year. ACOs in this program are provided a portion of the savings they generate.

From there, this incentive can be categorized among participating providers in the ACO according to the contractual contract formed by the member providers of ACO. At this point, revenue-sharing isn’t available to chiropractors but might be in the future.

If you are considering of partnering with an ACO as a contracted provider, be certain to read and review the agreement carefully. You need to find an agency that fits your requirements and respects your contribution. And you’ll be working with other providers to ensure your sufferers get the best care. Sufferers are free to see any Medicare provider, regardless of affiliation with an ACO, however ACO membership might generate referrals from other providers you’re affiliated with.

Engaging in an ACO

By contracting with an ACO, you’ve an opportunity to represent chiropractors to members of other healthcare professions. ACOs generally deal a range of different patient care requirements, so finding an agency to partner with permits you to find more chiropractic patients.

Few MD and DO physicians might be interested in referring their sufferers, so you should consider ACOs as a potential source of new patients. Your work will likely motivate more providers to value the contribution chiropractic care makes to holistic sufferer treatment.

You could generally form an agreement with an ACO as a contracted provider or, alternatively, work as part of a group practice. As the healthcare industry grows and transforms, ACOs will likely become a major part of Medicare. More providers are hoped to join and form new agencies, making ACOs a primary part of healthcare’s future.

You can have a role within this future and demonstrate the value of chiropractic patients. This might just be your opportunity to shape the future of Medicare and of primary care. By becoming engaged with an ACO, you are fulfilling a requirement and assisting to give chiropractic patients a voice in the next level of healthcare as Medicare searches improved coordination and greater savings.

 

Medicare ACOs Indicate savings, quality gains in the year of 2015

Medicare ACOs indicate better quality of care for Medicare beneficiaries while producing financial savings, in accordance to 2015 quality and financial performance data issued on the day of Thursday.

Alternative payment models like ACOs are meant to make better the quality and health results while decreasing the cost of care. Toward those ends, the Centers for Medicare and Medicaid Services (CMS) declared that more than 400 Medicare ACOs indicate or generated in excess of $466 million in total program savings previous year. That number involves 392 Medicare Shared Savings Program ACOs and twelve Pioneer ACOs.

CMS informed that overall quality scores for 9 out of 12 Pioneer ACOs scored more than 90% in 2015. Additionally, 125 Medicare ACOs qualified for shared savings payments previous year by meeting quality performance standards and their savings threshold.

“The outcomes indicate that more ACOs are sharing savings in the year of 2015, in contrast to the year of 2014, and that ACOs with more experience in the Pioneer ACO Model and the Medicare Shared Savings Program tend to perform better over time,” CMS informed.

Presently, there are more than 470 ACOs that facilitate 8.9 million Medicare beneficiaries. ACOs are “judged on their performance, as well as their betterment, on an array of meaningful metrics that assess the care they deliver,” involving “how highly sufferers rated their doctor, how well clinicians communicated, whether sufferers are screened for high blood pressure and their utilization of EHRs,” claims the August 25 announcement from CMS.

Deployed on a comparison of 2014 and 2015 data, the agency summarized that average quality performance improved over that time by more than 15% on key preventive care measures, involving screening for risk of future falls, depression screening and follow-up, blood pressure screening and follow-up, as well as offering pneumonia vaccinations.

In a proposed press conference, Patrick Conway, MD, CMS acting principal deputy administrator and chief medical officer, stated ACOs are part of the agency’s “broader strategy to make better the healthcare system by paying contributors for what works, unlocking healthcare information, and searching new ways to coordinate and integrate care to make better the quality.”

Although, to unlock the value of healthcare data, these agencies require not merely a strong health IT infrastructure but also the capability to exchange data. However, medicare ACOs indicate important investments in HIT, in accordance to survey results issued in early 2016; they continue to struggle with interoperability issues, making it complex to integrate data from disparate clinical sources.

The survey of sixty-eight Medicare and commercial ACOs by the eHealth Initiative and Premier Inc. discovered that while HIT enables them to accumulate the data they require to deliver quality care and make better the operational efficiency, data integration depicts one of the biggest obstacles to their success.

In the survey, 79% of respondents demonstrated that obtaining information from outside the ACO network was observed as the most formidable challenge facing ACOs, with 64% reporting that data integration was a huge obstacle to developing and operating their ACO.

 

AHA: Commercial ACO Tax Ruling hinders Value-Based Care Models

In a letter to the IRS, AHA elaborated that the recent decision to disqualify a commercial ACO from charitable tax exempt status could discourage value-based care for other contributors.

By stripping commercial accountable care organizations (ACOs) of their charitable tax exempt status, the IRS could be threatening the future of value-based care and care coordination, in accordance to the American Hospital Association (AHA).

In a letter addressed to IRS Commissioner John Koskinen, the AHA described that the recent ruling against upholding tax-exempt status for an unnamed ACO was unfounded. Non-Medicare ACOs promote better healthcare for different communities like Medicare Shared Savings Program (MSSP) ACOs and, therefore, deserve a nonprofit, tax-exempt designation.

“We’re seriously concerned that the IRS has adopted a ruling position that means nonprofit hospitals threat losing their tax exemption if they pursue a modern approach to clinically integrated health care that holds the largest promise for improving outcomes and reducing costs,” wrote Melinda Reid Hatton, the AHA’s Senior Vice President and General Counsel.

CMS Permots Few ACOs to Join New Value-Based Care Model

CMS has extended the participation requirements for the value-based care program CPC+ to include certain Medicare ACOs, involving the MSSP ACOs.

CMS has expanded the eligibility needs in the Comprehensive Primary Care Plus (CPC+) model to involve primary care physicians in certain Medicare accountable care organizations (ACOs), according to an updated fact sheet.

Up to 1,500 primary care practices out of the total 5,000 permitted in CPC+ can also be part of an ACO, reported CMS.

Although, only primary care practices that are participating in the Medicare Shared Savings Program (MSSP) are considered eligible for the new payment model, which is scheduled to begin on the day of January 1, 2017. Practices that are part of the Accountable Care Organization Investment Model, Next Generation ACO Model, or any other shared savings program are ineligible.

Top Three Ways ACOs Could Garner

Savings ACOs would benefit from adhering to state and federal laws, investing the time essential to operate this model of care, and pursuing risk-based payment contracts.

Payers and providers looking to operate through an accountable care organization (ACO) will require to adhere strictly to state and federal laws regarding the development of this model of care. Accountable care organizations are responsible for the quality and cost of care among a certain patient population and must abide by the laws and regulations that the federal government has passed in terms of ACO development.

Review state laws for ACO management

The National Law Review also discussed the significance of adhering to state laws with regard to operating an accountable care organization. There are several decisions that need to be made when forming an accountable care organization including who can employ physicians and the type of control that can be exerted between payers and providers operating an ACO. all of this directly relates to state laws and healthcare regulations.

Invest time and commitment

Along with abiding by federal and state laws, there are various measures that accountable care organizations can take to ensure success in the healthcare market. It is essential to invest the time and remain committed when operating accountable care organizations in order to reap the cost savings of such endeavors.

Pursue risk-based payment contracts

In case to reach the shared savings and obtain the revenue needed to maintain a successful ACO, it is beneficial to invest in risk-based payment arrangements with payers, stated Mark Wagar, President of the Heritage Provider Network.

“While they require to be careful about assuming more risk, I consider the greatest thing for ACOs is to be more aggressive,” Wagar explained. “There are too many healthcare agencies with potential that are sitting on the sidelines and saying ‘Let’s do just share savings because we can’t lose. We will bill for fee-for-service and if we happen to make better things, we get a bonus but otherwise, we don’t lose.’”

Mixed Outcomes for MSSP ACO Savings

High-cost ACOs in Medicare’s Shared Savings Program had an easier time earning shared savings than low-cost ones.

In accordance to a report from Leavitt Partners, 42% of accountable care organizations (ACO) residing in high-cost markets in the Medicare’s Shared Savings Program (MSSP) earned shared savings, while only 18% of agencies residing in low-cost markets earned shared savings. ACOs in the highest cost segment earned an average of $2.1 million, while ACOs from the lowest cost quintile earned $357,000. 26 percent of ACOs earned shared savings, the report stated. Although, these savings were very concentrated among a small amount of ACOs.

“The top 10 ACOs’ earned shared savings accounted for 30% of all 333 ACOs’ earned shared savings,” Leavitt Partners claimed. “While some ACOs are performing meaningfully well, most are not.”

Researchers pointed out that ACOs that covered more individuals typically didn’t earn more shared savings. However, they were capable to earn higher average quality scores.

The top 10 earning ACOs typically had higher quality scores. However, higher quality scores did not necessarily equate to shared savings, the researchers said. About 40% of ACOs in the most expensive markets “still failed to earn shared savings,” the report said.

Do Contributors Apply Population Health Management Inconsistently?

A deficiency of industry-wide guidelines for population health management may be launching inconsistencies into the process of selecting patients for care management.

There is important variation in the way individual practices select high-risk patients for participation in care management and population health management programs, in accordance to a new study published in the American Journal of Managed Care, although most providers do tend to target the older, sicker, and more socioeconomically complex members of their attributed patient pools.

The study reviewed more than 2600 Medicare beneficiaries receiving care within 35 practices of Partners HealthCare, a large Pioneer Accountable Care Organization (ACO) in the Boston area.

The researchers hypothesized that even though the practitioners within the ACO are incentivized to give comprehensive population health management and chronic disease care services to meet quality objectives and make better the outcomes, there may be significant variation in the way patients are identified and chosen to enroll in care management services.

AHA: MACRA Alternative Payment Model Incentives Require Modifications

CMS should make Alternative Payment Model incentives that make it convenient for contributors to become qualified rather than raising hurdles, AHA argued.

The MACRA Alternative Payment Model incentives should be executed in a way that offers the best chance for physicians to become qualified participants, the American Hospital Association discussed in a letter to CMS this week

MACRA gives incentives for physicians who indicate high-level participation in Alternative Payment Models. AHA claimed that it supports accelerating the utilization and the establishment of alternative payment models and delivery models to reward more effective and coordinated care for sufferers.

Various hospitals, health systems and payers are getting initiatives that better aligning provider incentives to acquire the Triple Aim of making better the sufferer experience of care, improving the health of populations and decreasing the price of care. One way contributors are meeting the aims of the Triple Aim is by making accountable care organizations (ACOs). They are also bundling facilities and payments for episodes of care and establishing latest incentives to involve physicians in making better the efficiency and quality, AHA noted. Although, the healthcare field is yet experiencing a learning curve.

“Instead of the growth made to date, the field as a whole is yet learning how to efficiently transform care delivery,” AHA stated.

Just a restricted number of APMs have been launched to the healthcare field so far. “Existing models haven’t gave participation opportunities evenly across physician specialties, AHA stated. As an outcome, a number of physicians might be utilizing APMs for the 1^st time.

AHA was disappointed that CMS has gave “a narrow definition of financial risk when recognizing advanced APMs, which count for intentions of the MACRA bonus payment.” CMS proposes to explain financial threat for monetary losses to need participants to take on downside risk. “This approach fails to identify the significant up-front contribution that must be made by contributors who establish and implement APMs,” AHA stated.

Contributors who engage in APMs are requited invest much time and resources to establish the clinical and operational infrastructures essential to better manage sufferer care. Forming an ACO is expensive. The estimated start-up prices for a small ACO are $11.6 million, AHA stated. For a medium ACO, the startup price is $26.1 million.

 

ACOs Keep Growing Across USA

The Patient Protection and Affordable Care Act led to the development of the Medicare and Medicaid Innovation Center, which suddenly brought the creation of accountable care agencies and the Medicare Shared Savings Program. Over the last various years, the number of accountable care organizations has grown tremendously around the country.

Leavitt Partners along with the Accountable Care Learning Collaborative made a study in the month of January 2016, as reported by the Health Affairs Blog that found a total of 838 accountable care organizations across all fifty states in the nation. In fact, the number of accountable care organizations has grown by 12.6% in just the last year.

In addition to these findings, there is currently more than 1,200 accountable care contracts being executed across hospitals throughout the US. The study discovered that 28.3 million sufferers are now getting medical services through an accountable care organization or ACO.

The Medicare Shared Savings Program is now on its 3^rd year and many ACOs have renewed their contracts while various have decided to forego another year performing under the accountable care contract.

BCBS of Arizona, McKesson Inaugurate ACO Partner — Four main highlights

In the collaboration and cooperation with Blue Cross Blue Shield of Arizona, McKesson is inaugurating ACO Partner, in accordance to HIT Consultant.

Here are 4 main highlights:

1. Through the ACO Partners, McKesson targets to increase the care management, population health services, physician engagement, and technology.


2. To make better the quality of care and decrease costs, ACO Partner has policies to contract with contributor groups and payers throughout the United States of America.


3. BCBS of Arizona is the 1^st insurance company to have a contract with ACO Partner, and facilitates as a main or primary investor in the ACO via the payer's subsidiary, Trinnovate Ventures.


4. Blue Cross Blue Shield of Arizona and McKesson contributed a lot to develop an infrastructure that will motivate the strategic collaboration between the contributors and physicians. The complex and infrastructure will also work to serve the continual patient engagement.

 

New Hospitals and Health Care Providers Combine Successful, Cutting-Edge Federal Initiative That Cuts prices

HealthEast and Entira Family Clinics, members of the Community Health Network (CHN), declare that CHN was selected as one of approximately 150 renewing Medicare Shared Savings Program Accountable Care Organizations (ACOs), offering Medicare beneficiaries with access to high-quality, coordinated care across the US, the Centers for Medicare and Medicaid Services (CMS). That brings the total to 434 Shared Savings Program ACOs serving over 7.7 million beneficiaries.

Doctors, hospitals and health care providers develop ACOs in case to work together to provide higher-quality coordinated care to their patients, while assisting to slow health care cost growth. Community Health Network will be one of 434 ACOs participating in the Shared Savings Program as of the month January 1, 2016. Beneficiaries seeing health care providers in ACOs always have the freedom to select doctors inside or outside of the ACO. ACOs receive a portion of the Medicare savings generated from lowering the growth in health care costs as long as they also meet standards for high quality care.

"Persons across America are going to be better cared for when they go to their health care providers, because these hospitals and contributors have made a commitment to innovation, a commitment to alter how they do business and care for patients," HHS Secretary Sylvia Matthews Burwell stated. "Medicare, and the health care system as a whole, is moving toward paying providers deployed on the quality, rather than just the quantity of care they give patients. The 3 new ACO initiatives that are being launched today mark an important step forward in this attempt."

Are We At an Inflection Point into Real Coontributor-Payer Convergence?

The closing keynote presentation in the Business of Healthcare Symposium on the day of Monday at HIMSS16 really assisted the crystallize so much about this moment in healthcare. Even the professional title of the presenter spoke to it. The presenter was Veeneta Lakhani of the Indianapolis-deployed Anthem, which insures 38 million covered lives across the U.S.A, and which has contracts with 796 hospitals and 54,000 contributors, and has over 4.5 million members in more than 154 ACO contracts nationwide.

Ms. Lakhani’s title? Vice president, contributor enablement.

Indeed, everything about Veeneta Lakhani’s presentation on the day of Monday after spoke to the present moment in U.S. healthcare And, following instantly after the remarkable presentation, “The ROI of ACO,” by Douglas J. Van Daele, M.D., vice dean for clinical affairs at the University of Iowa Health Care, Lakhani’s presentation spoke to the massive move in perceptions and interactions that has taken place among contributors and payers in the past decade.

Genuine Chose by Leading Healthcare Solutions Contributor ikaSystems

Genuine, a full-service digital-1^st agency, confirmed today it has added to its client roster ikaSystems, the premier contributor of enterprise, cloud-based business procedure and automation solutions for payers.

Deployed in Southborough, MA, ikaSystems delivers solutions that transform how health policies conduct commercial, Medicare, Medicaid, and ACO business. Genuine was involved to manage digital strategy, creative and website development responsibilities for the company.

Serving payers since the year 1999, ikaSystems' solutions deliver flexibility and high levels of service. Its consumers are situated across the US and involve payers of all kinds and sizes representing few 28 million covered lives. The company's solutions automate key procedures for sales, marketing, regulatory compliance, claims administration, customer service, quality management and revenue optimization.

Time, Commitment Needed for ACO, Value-Based Care Victory

In the healthcare, as in so many other places of life, patience is a true virtue. Contributors and payers pursuing ACO development will require having plenty of it before their care transformation attempts pay off with primary cost savings.

As contributors combine increasing financial incentive opportunities with better population health management programs, they may be capable to acquire many of the objectives of healthcare reform.

But accountable care organizations will require indicating commitment and perseverance if they are to reap the profits of value-based care.

CMS will create ACO claims, provider database

The Centers for Medicare and Medicaid Services will create a database containing the health information of Medicare beneficiaries who receive treatment with providers participating in an accountable care organization.

CMS said it will use the data collection to support policy activities and reimbursement for its programs to bundle payments and share savings.

Besides Medicare beneficiaries, the database will contain personally identifiable information about certain individuals participating in the ACOs, including healthcare sole proprietors, providers, key leaders and managers of ACOs and contact persons.

Some of the information could be patient claims number, which could incorporate a Social Security Number, address and date of birth, or ACO eligibility and contact records, including the home address of a key leader or manager; or ACO participant tax identification number, according to an announcement in the Sept. 19 Federal Register. The database will become effective Oct. 19. The public may comment on it until then.

Federal agencies must report when they intend to establish a new system with personally identifiable information and assure safeguards against its disclosure for other than its stated uses, including determining the eligibility of ACO applicants, to meet quality and other reporting requirements, under the Privacy Act.

“Relevant HHS personnel, and any CMS contractors, grantees and consultants assisting them, will use personally identifiable information from this system on a ‘need to know’ basis,” the notice said.

The Medicare Shared Savings Program aims to reward quality care and takes steps toward paying for quality and efficient care by promoting accountability for a patient population and coordinates inpatient and ambulatory services and encourages investment in health IT and redesigning care processes. Under the Pioneer ACO Model, up to 30 provider organizations will test alternative payment models that include escalating financial accountability and arrangements based on outcomes in quality and patient experience.

The programs are designed to carry out new delivery and reimbursement provisions under the Patient Protection and Affordable Care Act.

Providers seek vendor help with ACOs

By: Mike Miliard

As health organizations begin to feel their way toward accountable care models, a new report from KLAS explores how providers and vendors are putting the pieces together, finding varying levels of confidence in IT solutions' integration ability.

 For the new report, titled "Accountable Care: Providers Forge the ACO Trail," KLAS interviewed 197 providers at 187 organizations to get a picture of how they're approaching accountable care – and how health IT tools are helping (or hindering) their efforts.

The accountable care organization (ACO) is a care delivery model where groups of healthcare providers take collective responsibility for managing patients' long-term continuum of care. ACOs that cut care costs without missing quality targets receive a portion of the savings.

While only a third of providers surveyed by KLAS plan to pursue a formal Medicare ACO designation, the majority agree that accountable care is the way of the future.

"Accountable care will touch every aspect of an organization," said Jason Hess, author of the report. "Its changes have the potential of turning the healthcare world upside down – from patient care to administration to revenue cycle management to IT infrastructure. The internal challenges appear endless. Unfortunately, planning an ACO is further complicated by the fact that the final government rules have not yet been published."

There are no one-stop shops for providers' ACO IT needs, says Hess, especially since each ACO will be different. Many providers are looking to leverage a combination of technology solutions to fill in the gaps and meet ACO requirements. That said, providers see some vendors are more prepared than others – with the most integrated rising to the top.

Top-tier healthcare vendors Cerner and Epic currently lead the way in provider confidence as being most ACO-ready, according to the KLAS report. Despite a few integration and offering gaps, Cerner has already integrated many of the IT pieces needed to complete an ACO puzzle and is taking a proactive approach to working with individual needs of interested providers.

Epic is also perceived as being close to ACO-ready, the survey finds, with gaps found primarily in their analytic capabilities and their ability to share data with non-Epic systems.

The KLAS report also examines provider perceptions of ACO readiness for Allscripts (Eclipsys), CPSI, GE Healthcare, McKesson, MEDITECH, QuadraMed and Siemens.

"Providers describe a variety of planned HIT purchases for their ACO projects - including data warehousing and analytics, HIE and patient portals," said Hess. "Vendors whose offerings integrate best with providers' in-house systems will top the selection lists going forward."

To learn more about this report, visit KLASresearch.com/reports.