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 Next Wave Of ACO Evolution Gives Providers Chance To Be 'Real Winners,' Analysts Say

Accountable care organizations (ACOs) may or may not save public dollars, but they’re here to stay—and providers have a chance to revolutionize their profession if they seize the opportunities offered by ACO evolution, a new analysis claims.
 
Barley one in five ACOs has been able to save public dollars, but they “will not disappear,” analysts at Navigant Healthcare have concluded.
 
“Payers, wary of anticipated health cost increases in the coming decade, see these clinically integrated networks as a platform for negotiating bundled payments,” Navigant says in a new report on the evolution of accountable care groups. “And the sponsors of these ACOs—hospitals, medical groups, and their business partners—remain committed to the ACO model, despite early setbacks for many.”
 


But that represents a real opportunity for those post-acute providers that are committed to quality care, Navigant concludes. The profession is moving from what Navigant analysts call “ACO 1.0” to “ACO 2.0,” where coordinated care efforts will have to add “specialists and post-acute providers to the mix.”
 
“Bundled payments, we believe, will be integrated into traditional ACO 1.0 so that patient populations requiring acute interventions are managed within the construct of the clinically integrated network,” Navigant says in its report, issued earlier this month.
 
Navigant Managing Director Donna Cameron says that “the big winners” in the transition to the new model will be those providers that can offer person-centered care the most efficiently.
 
“As we look at the analytics of an episode of care—let’s say, a joint replacement—25 percent and up to 45 percent of the spend on that joint replacement is related to post-acute care and readmission,” Cameron tells Provider. “All of a sudden, when the whole system is looking for value-based purchasing, they’re very interested in what’s happening in the transitions to care in the post-acute sector.”
 
ACOs may never actually save money, but—given the pressure of regulators, Congress, private insurance companies, and even large employers desperate to cut costs—they’re here for the duration of the next step of health care’s evolution, Cameron says.
 
“We’re really seeing them cascading across all different types of payers,” she says. “The bottom line is, all the payers want to shift risks to these clinically integrated networks.”
 
All of that may sound like jargon, but it represents a revolution that will change everything for everyone, Cameron says.
 
“Historically, there has been this view that the health care continuum is like a relay race. And we pass the baton from the hospital to the acute care facility to the post-acute care or to the home health agency, or maybe home. And we’ve passed the baton, hoping it didn’t get dropped along the way. Now, at the end of the race, we’re asking, did the patient have a good outcome and did we achieve that in the most efficient way possible?” she says.
 
So, how will providers be ready to capitalize on this opportunity?
 
“The No. 1 thing that I share with my post-acute clients is that they need to be able to develop and articulate their value proposition,” Cameron says. “The winners on the post-acute side are going to be those entities that are excellent partners: They’re going to be very focused on quality, they’re going to be interested in variation in care, they’re going to be interested in reducing readmissions.”
 
Bill Myers is Provider’s senior editor. Email him at wmyers@providermagazine.com. Follow him on Twitter, @ProviderMyers.
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