ACO updates may include equity factors


The next-generation ACO model will expire at the end of the year. Emily Brower, senior vice president of clinical integration and physician services at Trinity Health, said that if the regulator decides to extend it, adding equity to the payment structure may become part of any update. Trinity said that since the model was launched five years ago, the care organization it is responsible for has saved $85.6 million.

Before the Medicare and Medicaid Service Center is expected to update the next-generation structure, the non-profit system of this 91 hospital is improving its ability to collect patient race, ethnicity, income, and other data by moving its different electronic health records. A platform.

“This is really a great opportunity to get to know the people we serve and take better care of them,” Brauer said.

Trinity Health ACO has also been asking its insurance company partners to provide these data, and is working with CMS’s healthcare payment learning and action network to establish a common method for understanding and collecting data.

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The health system began to participate in the next-generation model in 2016, taking a lot of downside risks in exchange for bonuses based on improving health outcomes and reducing the cost of medical insurance beneficiaries. According to the latest CMS data, it is one of 41 ACOs currently participating in the model, which saved Medicare more than $558 million in 2019.

The overall impact of the next generation on reducing spending while improving quality is being questioned. Former CMS administrator Seema Verma had previously touted the savings of the model, but a subsequent CMS report contradicted her findings and pointed out that the model “has not resulted in the expenditure in the previous two years compared with patients who did not participate in the program. There are statistically significant differences”.

Under this payment model, Trinity Health ACO created a network among 15,000 providers, who are then responsible for the clinical and financial results of the patient population assigned to them. About half of the clinicians participating in Trinity ACO are independent providers who are not employed by the health system.

Although it is not uncommon for health systems to adopt independent practices in their ACOs, Brauer says that Trinity’s approach can help smaller providers who may not have the resources to accept the substantial downside risks required to participate in the model. This may help promote equality among the 770,000 patients who have the right to participate in the program—regardless of their future.

Compared with richer communities, where there are more disadvantaged groups, doctors’ participation rate in ACO is lower, which may exacerbate the existing gap in the quality of healthcare. According to a 2016 health report, nearly 36% of primary care providers working in postal codes with the least black population participated in ACO, while 26% of clinicians working in postal codes with a high proportion of black populations participated One of the modes. Transaction report.

In October, the CMS Innovation Center released a strategic update for all its payment models, including a firm commitment to address fairness, understanding, and narrowing the health gap.

“They have already placed a bet on this. This will be the lens for CMS to launch any new model,” Brauer said.



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