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Providers Will Need Help To Make ACOs Fly Right

MANAGED CARE May 2013. © MediMedia USA
Editor’s Memo

Providers Will Need Help To Make ACOs Fly Right

John Marcille

Accountable care organizations (ACOs) promise a reconfiguration of delivery with the provider at the center of operations. The Centers for Medicare & Medicaid Services (CMS) has about 250 ACO contracts, as our cover story points out.

Author Peter Wehrwein reports that health plans for the most part are on board, participating in ACOs outside of the CMS demos in a big way and really trying to make a go of this thing.

To do that, though, the interaction between plans and providers will need to be more collaborative — in fact physicians will need help, something the insurers already offer.

“ACO payment mechanisms and financial incentives aren’t going to magically transform physicians and the way they practice medicine,” Jill Hummel, vice president for payment innovation at WellPoint, tells Wehrwein. The technology has evolved. In video game parlance, it’s the difference between “Super Mario Brothers” and “Call of Duty.”

WellPoint offers care management services to small practices on request. It also offers free access to the American College of Physicians’ “Medical Home Builder,” an online toolkit and resource center. “We have to get physicians off the fee-for-service treadmill,” says Hummel.

With great power comes great responsibility, and that means more work for physicians. Will they have the time?

“That’s a good question,” says Barry Newman, MD, the CMO at Westmed Medical Group, a 250-doctor multispecialty group. “That is why we have invested in additional resources like analytics to automate as much as possible and hired case managers, physician extenders, and other additional staff.”

The goal, he says, is to transfer as much work as possible from physicians so they can focus on critical evaluation and treatment decisions that require the expertise of a physician.