Payers and providers alike must adapt to leaner business models and patient populations that are older and frailer than a general patient population.
Medicare and commercial accountable care organization (ACO) models are not created alike.
MaineHealth ACO, which generated a Top 10 shared savings payment in the first performance year of the Medicare Shared Savings Program, has found that participating in MSSP is more financially challenging than commercial ACO contracts.
"From a financial perspective, our commercial payers are willing to help support the work that we do; so they see the value in our care management programs and the work that we do to integrate our physician practices," says Jen Moore, chief operating officer of MaineHealth ACO, based in Portland, ME.
"We do not get that kind of funding from the governmental programs," Moore says.
"All of the commercial payers are willing to pay a per-member-per-month fee to the ACO for doing care management, working to communicate within our care network and being the liaison between our providers and the payer. They see tremendous value in all of that."
Commercial accountable care contracts tend to have better financial incentives than MSSP offers for physician practices that participate in MaineHealth ACO, she says.
"For the physician practices, [commercial health plans] are willing to pay for pay-for-performance. So they will have a shared-savings arrangement; but many of them will also say, 'If you are also successful on quality metrics, then we are willing to pay you additional dollars for that success.' "
Christopher Cheney is the senior clinical care editor at HealthLeaders.