Incentives, Motivations Clash Under ACOs
"If you're in central Florida, with 90% of patients on Medicare, you're not multipayer," he says. In other words, commercial ACOs hold no appeal for you. "It all comes down to where your bread is buttered."
The point of the new research, Perez says, is that it gives you the rules of the game at a high level. For example, commercial ACOs place greater focus, not surprisingly, on areas of cost reduction and the ambulatory process, while Medicare ACOs emphasize quality outcomes.
The metrics overlap to some degree, but participation in more than one ACO means you either have to implement different standards and protocols for each patient population, or you have to be willing to lose out on some metrics to better meet others, and to keep from driving your clinicians crazy. That depends on your payer mix, of course, as well as your ability to leverage data.
But what if some of the incentives are diametrically opposed—that is, what if they work directly against one another?
Try not to worry about that at first, Perez cautions, when I push on that question. For example, he says, if you do decide to go multipayer in your ACO strategy, there is tremendous overlap in areas such as breast cancer and colorectal screening. Those are no-brainers. But the overlap continues into other high-revenue areas, such as cancer treatment and diabetes.
"If you're going to really focus on something that has an impact, those are common across Medicare and commercial ACOs," Perez says. "Disease-focus areas are really very important."
- EHR Systems 'Immature, Costly,' AMA Says
- Anthem Blue Cross, 7 CA Health Systems Create New Challenger, Business Model
- Interstate Medical Licensure Effort Advances
- Better HCAHPS Scores Protect Revenue
- Data Points to Boom in Private HIX
- How to Build a Health Plan from Scratch
- Few Winners Among MSSP Participants
- CEO Exchange: Preparing for Population Health
- Narrow Networks Cut Costs, Not Quality, Economists Say
- Insurers see cost hikes in Partners HealthCare (MA) mergers