Accountable Care Trends, Strategies, And Best Practices

By Justin T. Barnes, former VP of Greenway Medical Technologies, Co-Chairman of the national Accountable Care Community of Practice, and Chairman Emeritus of the HIMSS EHR Association

Movement within the nation’s healthcare system has been swift and broad-­‐based since the October 2011 Centers for Medicare & Medicaid Services (CMS) Shared Savings Final Rule.

By the time 32 CMS Pioneer Accountable Care Organizations (ACOs) targeting Medicare patients were named two months later, private care coordination models for multi-­‐organizational community of care structures and payment variables were quickly embraced by a system poised for change.

By the end of summer 2012, more than 200 accountable care communities had formed in more than 40 states as privately driven or CMS models.

Trends within this total show that private-­‐sector ACOs began outpacing CMS programs at a four-­‐to-­‐one ratio beginning in 2012. During the same time period, the number of provider-­‐sponsored ACOs doubled to more than 70, an evolution expected to continue to trend upward.

Given the unlimited potential for practice-­‐led programs, the best-­‐practice challenges for providers seeking to join or establish a CMS or private program in conjunction with payers and other caregivers are technological, financial, legal and simply finding the right seat at the right table.

The reality for healthcare providers is that the time is now to examine models being proposed or forming that could impact future success. It is essential to engage peers in discussions of their knowledge and strategies, or attend informational sessions by payer or insurance groups, industry and community leaders, hospitals or regional CMS offices. (Hospitals remained the largest sponsors of private ACOs through summer 2012.)