Mass. Study: Savings ‘Spillover’ From Blue Cross Global Plan

(401(K) 2012/flickr)

(401(K) 2012/flickr)

Health wonk alert: If you can define an ACO (Accountable Care Organization) and know a little bit about the AQC (a pioneering global payment experiment by Blue Cross Blue Shield of Massachusetts), then read on.

There’s evidence from a study just out in JAMA that when doctors change the way they care for one group of patients (as with the AQC), there is a spillover benefit for other patients (in this case, Medicare).

Dr. Michael McWilliams says doctors who were part of the AQC, but weren’t being paid through a global budget for their Medicare patients, still cut Medicare spending by 3.4%.

He says the savings “would suggest that providers aren’t just targeting changing, but are changing their processes of care in a more systemic way such that the value of care they deliver to all patients is higher.”

That claim is harder to prove if you look at the quality of care Medicare members received as compared to patients in the Blue Cross ACQ.  McWilliams found some spillover to quality improvements.  Doctors provided fewer unnecessary MRIs for back pain and more consistent cholesterol testing.  But other “quality measures” such as reducing readmissions or preventable hospitalizations did not migrate from Blue Cross to Medicare members.

In Massachusetts, these findings may not have much practical effect for patients.  Most residents on Medicare have moved into one of the Pioneer ACOs, where doctors have incentives to spend money more wisely and boost preventive care. But it’s an interesting finding given that a lot of doctors talk about feeling ‘”schizophrenic” when they have to manage some patients who are on global budgets and others who are not, who are still fee for service.

For the nation, McWilliams says the findings show that contracts like the AQC have the “potential to foster systemic changes in care delivery.” From the press release on the study: Continue reading

How To Sell Us On Your ACO

Accountable Care Organizations are hot and getting hotter, nationally and as part of the Massachusetts health reform that just became law. (What are they? We try to explain in the 5-minute cartoon above.)

So the latest Healthcare Savvy post from WBUR’s Martha Bebinger is supremely timely: She puts the health care establishment on notice about what she, as an unusually savvy health care consumer, is looking for in an ACO. And as her less savvy but similarly health-care-minded colleague, I can only say, “Right on, Martha. Everything you want, I’d want too.” (Except for maybe the acupuncture.)

WBUR’s Martha Bebinger

Readers, to mangle Freud’s classic what-does-a-woman-want phrase: What does a patient want?? Now, as more and more ACOs are being formed, would be a great time to weigh in. Martha’s post begins:

I keep hearing that one day soon we’ll all be members of an Accountable Care Organization (ACO). These are big or biggish health care groups that include doctors, hospitals, labs, rehab and other things I need. The deal, as I understand it, is that I get everybody coordinating my care “under one roof”, but I’m not supposed to go outside that roof for care. I know, some ACOs let patients continue to have unlimited choice, but that doesn’t seem to be the model.

If I’m going to give up the option of going wherever I want, then what I get under that one roof better look pretty good. So, you ACOs out there, that are getting ready to sell me on your services, here’s what I’m looking for:

1) A primary care doc who responds pretty quickly to my calls, emails, texts or Skype (or has a fabulous nurse practitioner or physician’s assistant who gets right back to me). Someone who routinely asks how I’m feeling, not just whether my body is OK. Someone who makes eye contact and can explain what’s going on with words I understand.

2) A dentist who does the same (and who shares records with my doc.)

3) Evening and weekend office and lab hours. Continue reading

Cartoon Solves Health Care Puzzler: What The Heck Is An ACO?

Ladies and gentlemen! Announcing a whole new film genre: Wonk Cinema!! And what we hope will be the first in a series of CommonHealth cartoons dedicated to helping people stay awake as they learn about important health care changes that affect their lives.

Our first topic: “What the heck is an Accountable Care Organization?” Five minutes, just five minutes, to unravel one of the great mysteries of the universe! Explain the inexplicable! Destultify the stultifying! Also, to cast much-needed light on a health care phenomenon that is sweeping the state and the country…

We’re taking requests for other topics so soporific and esoteric they can only be explained tolerably in a cartoon video. What should we do next? Tiered health insurance? Payment reform? Please lodge your suggestion in the Comments section below.

And deepest thanks to former Boston Globe health care reporter Jeffrey Krasner, now president of Krasner Health Strategies, for lending his deep knowledge and rapier wit to this project. Continue reading

What Boston’s Pioneer ACOs Will Mean For Patients

As we reported last week, five Boston area hospitals and physician groups will have a dominant role in a federal experiment that could transform Medicare. All Medicare patients who see doctors through Atrius Health, Partners HealthCare, Beth Israel Deaconess Medical Center, Mount Auburn Hospital or any of the Steward Health hospitals will be affected.  The question is how?

The Centers for Medicare and Medicaid Services (CMS) today announced 32 organizations that will “Pioneer” the move to accountable care organizations (ACOs). Greater Boston, with five of the 32, will have a large concentration of doctors and patients testing ways to coordinate care and reduce costs.

Medicare rules become the standard for payments and care at most hospitals.  So when these major groups in Boston start doing more preventive care or requiring more interaction among all a Medicare patient’s doctors, the same practices will likely apply — eventually — to patients of all ages.

This pilot will not restrict where patients go for care. Hospitals and doctors will be rewarded for beating their prior spending thresholds and for showing patient care improvements. These groups could lose money if patients need more care than they have in the past or if they get a lot of expensive care that isn’t coordinated.

CMS says this experiment could save $1.1 billion over the next five years.  That’s a lot of money, but keep in mind that the Medicare budget this year is $468 billion.

We asked leaders of each Boston area organization to answer this question: How will joining this pilot project affect the way you care for Medicare patients? Continue reading

Mass to Have 5 of 30 or so Federal ACO Pilots

Massachusetts will have a dominant presence on Monday in DC when federal officials announce the names of hospitals and physicians selected as Pioneer ACOs.  The 30 or so networks in this pilot will demonstrate how to become an Accountable Care Organization (ACO).  The five Massachusetts groups are expected to be: Partners HealthCare, Steward Health Care, Mount Auburn Hospital and the Mount Auburn Cambridge Independent Physician Practice (MACIPA), the Beth Israel Deaconess Physicians Organization (BIDPO) and Atrius Health (the state’s largest independent physicians group).

“The large number of Boston area pilots will keep Massachusetts in the spotlight on national efforts to control health care costs for some time to come,” said one administrator who was not authorized to speak.

The “poster boys” for ACOs may not be part of the CMS pilot. Some of the doctors who plan to take part from Massachusetts call this experiment nerve wracking because it is an untested way to lower costs and improve care.  It is an ambitious experiment for the Boston area. Most Medicare beneficiaries will now receive care from a doctor or in a hospital that is operating as an ACO.

CMS defines ACOs as…

“groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.”






Questioning The Latest, Greatest Medical Technology

Harvard economists ask why experimental technologies such as proton beam therapy is so generously reimbursed?

Here’s a healthy dose of skepticism from Harvard economists wondering whether so-called Accountable Care Organizations, or ACO’s, can truly bring down the cost of health care, and specifically, whether doctors and hospitals working under this new model can limit their appetite for the snazziest new (expensive) technology.

The context for the report, by Harvard’s Katherine Baicker and Amitabh Chandra is one in which: “…highly cost-effective treatments like aspirin and flu shots are underused, while angioplasty is used in both lifesaving and inappropriate cases and exorbitantly unproven procedures such as proton beam therapy are generously reimbursed by public programs.”

NPR’s Health Blog details their paper, called “Aspirin, Angioplasty, and Proton Beam Therapy: The Economics of Smarter Health Care Spending:”

In a paper delivered last week at a Federal Reserve Bank of Kansas City symposium in Jackson Hole, Wyo., [Baicker and Chandra] warned that ACOs may not want to rein in the use of expensive technologies that haven’t been proved superior to old-fashioned approaches, since the new stuff is often a major lure for patients.

They write:

[W]e do not know how well ACOs will sidestep cost-ineffective technologies, particularly if the latest shiny innovation increases market share. The viability of ACOs will depend on the receptiveness of physicians to capitated payments — some specialists will see their incomes fall and are unlikely to take these cuts quietly. While their concerns may not resonate with patients, they might if providers claim that valuable care is being withheld. Designers of ACOs are therefore keenly interested in measuring ACO performance and patient satisfaction, but current quality measures only capture truly negligent care.

The authors also warn that even if ACOs do achieve savings by performing fewer procedures, “some of the savings from lower quantities may be offset with higher prices as ACOs exert market power” by charging more to private insurers.