A study recently released by the Commonwealth Fund shows that early implementation of accountable-care organizations around the country is being governed mostly by physicians and hospitals, not payers.
The study shows 51 percent of all ACOs are built as a joint venture between doctors and hospitals, like the newly approved Barnabas Health ACO-North LLC, and another 20 percent are physician led, like the Optimus Healthcare Partners LLC group.
Accountable-care organizations were created under the Affordable Care Act as a way to streamline care coordination for entire populations of patients while making care better and more affordable.
The survey also revealed 18 percent of ACOs, as of September 2011, are hospital led, like the Atlantic ACO, which is led by Atlantic Health System and the Valley Health System. Only 2 percent of ACOs formed are led by payers, like the Horizon Blue Cross Blue Shield New Jersey partnership with Optimus Healthcare or the Aetna Inc. ACO with Hunterdon Medical Center.
Stephen Timoni, a health care attorney at K&L Gates LLP, in Newark, said most of the New Jersey ACOs he's seen are led by hospitals.
"That's going to be somewhat of a battle, between the hospitals and the insurers, to see who can get the physicians on board," Timoni said. "That's the important part of the ACO, the physician integration. … A hospital that creates an integrated care model that may include a lot of facilities on the real estate side — ambulatory care centers, imaging centers, other diagnostic centers, laboratories — that's all good, but without the physician integration, you really don't get where you need to be."
The report also noted that hospital- and physician-led ACOs tend to focus more on primary care than acute care, but Horizon Blue Cross Blue Shield's partnership with Optimus is set up to promote primary care based on patient-centered medical home models, according to spokesman Tom Vincz.
"Horizon ACO arrangements include incentive payments to support improved patient care coordination and fund other activities to further transform offices into patient-centered practices," said Horizon in a statement from Vincz. "Entities that Horizon collaborates with are given other valuable resources, such as timely, population-based data, to help them deliver more effective and efficient care to their patients."
According to the Commonwealth report, 75 percent of hospitals surveyed were not planning on participating in ACOs as of September 2011, and only 13 percent were already participating. Top challenges identified in starting an ACO included taking on financial risk, increasing patient population size and reducing clinical variations.