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Forget MSSP, You've Already Started a Commercial ACO

Karen Minich-Pourshadi, for HealthLeaders Media, March 5, 2012

In the HealthLeaders Media 2012 Industry Survey cross-sector report, just 13% of healthcare leaders say their organization plans to join a commercial ACO. However, 51% plan to be part of a Medicare Shared Savings Program—the so-called Medicare ACO.

It seems that many healthcare leaders may not recognize they already have the foundation in place for a commercial ACO that could prove more lucrative than the MSSP.

It's illogical to me that providers are so eager to join the ballyhooed Medicare ACO or even the Medicare Pioneer ACO program without first creating a commercial ACO. Why focus attention on secondary payers (Medicare and Medicaid) when primary payers (commercial insurers) are interested in establishing programs that should garner greater shared savings than anything being offered by the government?

This incentive certainly should inspire earlier adoption of a commercial ACO before the MSSP, and I think we'll see more announcements of these pursuits in the coming year.

Just last week Blue Shield of California, Greater Newport Physicians (an IPA of more than 500 doctors), and Hoag Memorial Hospital Presbyterian in Newport Beach, CA, announced a three-year accountable care initiative to provide integrated, cost-efficient care to approximately 11,000 Blue Shield HMO members in Orange County.

The providers and payer involved with this ACO, which starts July 1, 2012, will share clinical and case management information and coordinate healthcare services. The provider organizations' will align their incentive structures to improve healthcare quality and patient service while reducing costs.

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