Tag Archives: ACO
Four predictions for the future of healthcare
Healthcare policy has long been a moving target, but it’s hard to remember a time when more change was cycling through the industry. Now, more than half a decade since the passing of the Affordable Care Act (ACA), the focus has shifted from expanding access to health insurance to reforming the delivery of healthcare.
In particular, policymakers have embarked on a series of experiments and initiatives to transition from the traditional fee-for-service (FFS) system to a payment-for-value delivery system, with key attention to cost containment and quality improvement.
We are in the first generation of pursuing approaches better than FFS, and expect the industry’s shift toward value-based care (VBC) to accelerate and continue to impact providers, patients, vendors, and payers in different ways.
Now a little more than halfway through 2016, we thought it would be a good time to look at trends in the industry and how they will shape the relationships among stakeholders for the years to come.
Canopy Health Receives License, Names New Leadership; Accountable Care Network Builds Executive Team to Spur Bay Area Growth
http://finance.yahoo.com/news/canopy-health-receives-license-names-221800300.html
Canopy Health, the Bay Area-wide health care network being developed by UCSF Health, John Muir Health and three physician groups, has received its Knox-Keene license to operate in seven Bay Area counties. It also has built out its management team, naming Meg Durbin, MD, as chief medical officer and Patrick Caster as chief financial officer.
The restricted license from the California Department of Managed Health Care enables the network to provide services in Marin, Southern Sonoma, San Francisco, Alameda, Contra Costa, and portions of San Mateo and Solano counties. Canopy Health will contract directly with health plans on behalf of all providers who are part of the network to develop an insurance product that provides access to high-quality care at an affordable price. Canopy Health currently includes more than 4,000 physicians and 12 hospitals throughout the San Francisco Bay Area.
“Our model is unique, as we are partnering with health plans to offer a competitively priced insurance product, rather than selling our own plan,” said Canopy Health Chief Executive Officer Joel Criste. “By accepting risk, we are accountable for the overall health of the patients we serve. It puts the focus where it should be – keeping patients as healthy as possible and providing the care they need in the most appropriate setting, whether that is the primary care physician’s office, an outpatient center or acute care hospital.”
UCSF, John Muir dramatically expand, rename Bay Area health network
UCSF Health and John Muir Health have dramatically expanded — and renamed — their year-old Bay Area accountable care network, adding seven new hospitals and three new medical groups to the enterprise.
The hope is that the network will be competitive with giants like Kaiser Permanente and Sutter Health. The network’s new brand name — Canopy Health — is intended to reach out to the broad Bay Area community, network CEO Joel Criste told the Business Times Wednesday.
“We’re off and running,” UCSF Health CEO Mark Laret added, in a Wednesday afternoon interview. Laret called Canopy Health’s recent growth spurt “the beginning of something that could be very big,” potentially a model for hospitals and medical groups nationally to use as a template, and a strong, multi-hospital and medical group alternative to Kaiser Permanente, in particular.
Hill Physicians Medical Group, one of Northern California’s largest independent practice associations, the East Bay’s Muir Medical Group IPA and the North Bay’s Meritage Medical Network have quietly joined in recent months, as shareholders and participating providers in the venture, officials told the Business Times.
The two founding organizations still hold the largest stakes and are clearly running the show, however.
The new additions give the network more than 4,000 affiliated doctors in the Bay Area, which in turn gives more clout when competing with regional rivals like Kaiser and Sutter.
“It’s an important step that allows them to position themselves as a system to compete with Kaiser, Sutter and Stanford Health Care,” among others, said Walter Kopp, a longtime Bay Area hospital and medical group consultant.
Association Between Medicare Accountable Care Organization Implementation and Spending Among Clinically Vulnerable Beneficiaries
“Medicare ACO programs are associated with modest savings on average across all beneficiaries, with savings concentrated in clinically vulnerable beneficiaries and use of institutional settings.”
Where’s the value in accountable care?
Accountable care is supposed to be about paying for value. But six years after passage of the Affordable Care Act heralded the shift away from fee-for-service, Dr. Greg Carroll, corporate clinical leader of GOHealth Urgent Care, has an important question: “Where’s the value?”
Survey reveals 3 value-based payment trends to watch
Health policy leaders to HHS: More bundled payment models, please
- The Center for American Progress (CAP) and other health policy leaders issued a joint letter to HHS Secretary Sylvia Burwell advocating further advancement in Medicare payment reform.
- The signatories seek additional mandatory bundled payment demonstrations, arguing they would show stakeholders — including hospitals, physicians, device manufacturers, skilled nursing facilities, and home healthcare agencies — that aggressive expansion is coming for bundled payments and other payment reforms.
- CAP has long advocated for Medicare to expand its most successful bundled payment models, including its Acute Care Episode demonstration project.
Health Affairs Study On Hospital Profitability Gives Us Some Important Factors To Watch Going Forward
Bai and Anderson report two profitability-related factors that reflect the effect of hospital consolidation trends: regional power and system affiliation. Regional power refers to hospitals that face less competition in their local markets, while system affiliation indicates hospitals that are part of multi-hospital systems. Both are associated with higher profitability in their study.
More and more hospitals across the country are joining systems that operate outside their local markets. This is due, in part, to the fact that antitrust regulators have limited local market mergers but have not, in general, adapted their models of hospital market competition and antitrust to address non-local mergers. As a result, hospitals in some instances are able to join systems, gain market power, and raise their prices without necessarily improving quality or service. My own research in this area (forthcoming inINQUIRY) shows that hospitals that are part of the largest multi-hospital systems in California were able to negotiate price increases that are consistently well above all other hospitals in that state.
How Kaiser Permanente is reinventing emergency care
Multispecialty hubs that integrate office-based primary and specialty care with traditional emergency department functions have improved clinical care, increased access and lowered costs compared with the traditional model of medical offices and community hospital EDs, according to the Kaiser Permanente executives pioneering the hub model.
Kaiser Permanente, Mid-Atlantic States (KPMAS) pioneered the multispecialty hub model beginning in 2012 with five full-service medical buildings, each of which serves about 100,000 patients in Virginia, Maryland and the District of Columbia, according to an article in NEJM Catalyst.
http://catalyst.nejm.org/how-multi-specialty-hubs-fill-a-major-gap-in-the-care-continuum/
HENRY KOTULA 