Case 13.1 Incentives in Accountable Care Organizations An accountable care organization (ACO)…


Case 13.1

Incentives in Answerable Care Organizations

An answerable attention structure (ACO) represents a consortium of doctors, hospitals, and other yieldrs who contract to follow financial commission for the character of attention. As such, it faces a complex inducement quantity, needing to authenticate contracts that remit it to converge its character and require targets. An ACO to-boot needs to organize contracts delay providers that incentivize them to yield causative, excellent-character attention. In addition, the ACO must do this as the yieldrs are simultaneously life paid using unwritten volume-installed methods, bundled liquidations, and a difference of alternative liquidation examples. Whitman (2017) quotes Micky Tripathi, author and CEO of the Massachusetts eHealth Collaborative, as byword, “What makes a lucky ACO? As an assiduity, we don’t perceive.”

A consortium that decides to shape an ACO contracts delay Mediattention for three years. Mediattention sets a benchmark that is a weighted medium of spending by beneficiaries that are attributed to the ACO. One coil is that consortia delay excellent levels of spending in the elapsed find it easier to converge require goals. In dissimilarity, marketable ACO contracts are installed on a negotiated objurgate and a negotiated quantity of endanger.

For in, UnityPoint Health, a $4 billion regularity delay 43 hospitals resisting Iowa, Illinois, Wisconsin, and Missouri, has a physician-led ACO that in 2016 mature 70,672 Medicare beneficiaries in the Mediattention Next Generation ACO example. Through its self-insured sanity delineation and its ACO contracts delay privy payers, including UnitedHealthcare, Wellmark, and Blue Cross and Blue Shield of Illinois, it mature another 255,379 people, delay 102,125 of those in full-risk contracts (UnityPoint Answerable Attention 2017). UnityPoint did not attenuate requires in its primeval attempts at a Mediattention ACO but thus-far plain a regularity for reducing requires. The regularity tracks excellent-endanger patients, standardizes attention pathways, uses analytics to discern the population it serves (and the attention life yieldd), and emphasizes incorporating behavioral sanity into primary care.

UnityPoint Clinic, which has 500 physicians resisting Iowa and Illinois, now bases 86 percent of wages on productivity. By 2020 it delineations to confirm 33 percent of physician wages installed on productivity, 33 percent installed on compensation, and 33 percent installed on require, quality, and remuneration measures (Barkholz 2017). The logic is that yieldr payments need to be aligned delay liquidations for attention.

Discussion Questions

• Why is creating a lucky ACO difficult?

• How sundry Mediattention ACOs are there? How are they structured?

• How sundry marketable ACOs are there? How are they structured?

• How sundry Medicaid ACOs are there? How are they structured?

• Is the sum of ACOs increasing or decreasing?

• What outcomes portray luck for an ACO? What predicts luck?

• Do ACOs that confirm past endanger get past shared savings? Why?

• Do some ACOs ameliorate clinical character? How do they do it?

• Do some ACOs ameliorate patient satisfaction? How do they do it?

• How does life paid in multiplied ways complicate ACO intention?

• How does life paid in multiplied ways feign provider inducements?

• What order of inducements does uncorrupted volume-installed liquidation fashion for yieldrs?

• What order of inducements does a mixed liquidation example fashion for yieldrs?

• What order of inducements does uncorrupted compensation fashion for yieldrs?

• How does MACRA feign inducements to fashion a Mediattention HMO?

• What inducements does the Medicare benchmark fashion?