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Health Plan, Provider Partnerships May Trump ACOs

Margaret Dick Tocknell, for HealthLeaders Media, May 2, 2011

Parke says a health plan could require members to comply with care coordination and case management to improve their health and help reduce costs. According to the proposed CMS rules, patients in ACOs can opt out of care coordination by refusing to share their personal medical information with all of the providers. But, they will still be counted as part of the ACO and thus will affect the quality points earned for financial incentives.

Why would a health plan want to be in a partnership? Parke says there is growing acceptance that integrated delivery systems are more cost effective and will allow a health plan to have more competitive premium rates.

Also, once the partnership is up and running, the health plan can delegate some of the administrative functions to the integrated delivery system. That will make it easier for the health plan to meets its surplus and profit goals under the Affordable Care Act.

See Also:

Leaders Respond to CMS' Proposed ACO Regulations
The Bridge to Accountable Care Organizations
13 Hot ACO Buzzwords All Providers Should Know
2011 HealthLeaders Media Industry Survey


Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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1 comments on "Health Plan, Provider Partnerships May Trump ACOs"


Mike Barrett (5/2/2011 at 10:21 AM)
There is an interesting juxtaposition of demanding great precision in a care process, but not providing any precision on a population basis. Clearly the message is do the care process on all patients, accept the fuzziness on financial/reporting metrics. The net result is trying to advocate for the environment described in the draft regulations to a Board of Directors/Trustees as career limiting compared to a "wait and see" for both final regulations, success/failure, what ever else the policy types will come up with for the next alternative. I think the provider segment is genuinely disappointed that the draft regulations describe a "bridge too far." One can only speculate as to why CMS established such a hard journey compared to all the other paths.