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Doctors Feel Pressure to Accept Risk-based Reimbursement

Jacqueline Fellows, for HealthLeaders Media, July 24, 2014

The transition to value-based purchasing is far enough long now to assume that while an ACO might not be called an ACO five, 10 or 20 years from now, the reimbursement model it is trying to become will be in some incarnation in the future.

Larger physician groups, as Cigna is betting on, have the resources to be positioned for this transition, but smaller physician groups are either not ready or capable, according to a March study from the Journal of Health Services Research.

The study found that 60% of physician practices were not participating in an ACO; 25% did belong to an ACO, while 15% planned on joining one in the future.

And even though the study showed that more than half of physician practices were not part of an ACO, the study's authors indicated that figure was high not necessarily because doctors had turned up their noses to the payment and care delivery model (though there are more than several examples of physicians and physician groups avoiding ACOs and similar arrangements).

Instead, the study concluded that based on its more than two dozen indicators measuring care management, quality, and other patient-centered medical home processes, physician practices that were not in an ACO scored lowest.

With the study's sample showing that if practices with more than 100 providers, it indicates smaller practices aren't ready to participate in an ACO.

Size Matters
Las Vegas-based HealthCare Partners Nevada is very familiar with providing value-based care. As a network of more than 200 primary care physicians and more than 1,300 specialists, Todd Lefkowitz, senior vice president of managed care operations and network development, says nearly half of its 250,000 unique patients are in some sort of value-based contract.

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