July 18, 2012
By Haydn Bush, H&HN Senior Online Editor
While accountable care organizations have been a hot topic in the health care provider community for most of the two years since their inclusion in the Affordable Care Act, public awareness of ACOs is still relatively low. Few, if any of the media coverage following the Supreme Court’s ruling on health reform last month mentioned ACOs, amid the hoopla over the upholding of the individual mandate and the new uncertainty over state Medicaid expansions. And I don’t think I’ve ever heard the term come up in a conversation with someone who doesn’t work in health care — most Americans are, unsurprisingly, more interested in how the law’s insurance provisions will impact them and their families.
So when I recently chatted to David Shulkin, M.D., president and CEO of Morristown Medical Center, a participant in the Atlantic ACO in New Jersey, I was interested to learn more about their efforts to reach out to the Medicare beneficiaries it will ultimately care for. ACOs participating in the federal shared savings program administered by the Centers for Medicare & Medicaid Services are required to inform all beneficiaries of their enrollment — and while Medicare enrollees can’t opt out of ACOs, they can stop their physicians and hospitals from sharing their data with other participants.
…Only time will tell if the ACO will be able to hit the quality and cost benchmarks required to receive shared savings payments from CMS — the early findings won’t be out for 18 to 20 months — but Atlantic is already working to develop a health information exchange and develop best practices across providers for several chronic conditions, including congestive heart failure, Marc Goldstein, vice president for physician services at Valley Health, told me recently.
“This is an experiment hospitals, physicians and nursing homes can take on with very little risk and learn to work together for the benefit of patients,” Goldstein says…