ACO Lessons from Early Adopters Are Invaluable
Hospitals haven't had to price risk very often in the past. Where they have, they've often relied on outside advisers for help. This has happened in situations such as mergers or capital access, but they've certainly never needed that kind of expertise on reimbursement.
The addition of risk to hospital contracting is a valuable tool for extracting maximum value from healthcare, but it's fraught with potential landmines. With risk, however, should come the promise of return, and hospitals and health systems that are ready to take it on should have a solid foundation for the future.
What resulted from my roundtable on ACOs with hospital and health system CFOs was a discussion on innovation, because what these organizations are doing is far from trying to fit into a predetermined definition of accountable care.
Instead, they're testing innovative approaches with commercial payers to reward for quality and to more closely align the pieces of the healthcare delivery chain as patients experience them.
They're experimenting with new skills necessary for their labor force to put more emphasis on total, or "population" health instead of volume. If they're not big enough, they're not only taking on risk through their commercial contracting, but taking and passing on risk through subcontracts with nursing homes, home health agencies, skilled nursing facilities—you name it.
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