They detailed the value of payers, who bring money, data, modeling, and benefits to ACO partnerships:
Slattery and McCoy each noted the significant costs involved in building the infrastructure necessary to transition to ACOs. The American Hospital Association places the cost at $1.7 million to $12 million to develop the infrastructure and resources needed, including information technology, care management programs, and patient-centered medical homes. Aetna, which is developing a national ACO network, has earmarked about $1 billion to help providers develop ACOs.
ACOs need to manage claims data to identify and monitor key populations, especially individuals with chronic diseases. Payers have a gold mine of data to help providers manage care and the healthcare services being used.
Payers can provide the population health analytics critical to targeting services and establishing performance targets. This information is critical to being able to meet the patient quality and outcome standards that measure the value of care.
Payers can support benefit designs that encourage healthy living, such as smoking cessation. Although the value of wellness programs has been questioned, healthcare reform requirements are designed to shift the wellness focus from a marketing orientation to value and outcome-based programs, such as free preventive health screenings and reduced copayments for maintenance medications.