Tuesday, December 4, 2012

Fwd: qotd: Physicians find insurer ACO payment models "completely unfavorable"

Quote-of-the-day mailing list

-------- Original Message --------
Subject: qotd: Physicians find insurer ACO payment models "completely
Date: Tue, 4 Dec 2012 10:44:08 -0800
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>

American Medical News
December 3, 2012
Medical practices wary of insurer efforts on new payment programs
By Victoria Stagg Elliott

Medical practices have a low opinion of how insurers are operating
emerging payment programs, such as accountable care organizations,
patient-centered medical homes, shared savings and payment bundling,
according to a survey of 800 practices released Nov. 14 by MGMA-ACMPE.

Researchers asked practices to rate the willingness of seven large
payers to engage in innovative models on a scale of one, meaning
completely unwilling, to five, which indicates completely willing.
Medicare Part B scored the highest at 1.95, and United Healthcare was
the highest private payer at 1.82.

When asked to rate the favorability of these payment models to the
practice on a scale of one to five, Medicare Part B scored highest at 1.68.

Health industry insiders said the scores on innovative payment models
reflect physicians' frustrations with programs they believe were not
designed for their specialty or size, and that insurers were not
flexible in negotiating terms.

ACOs serve 25 million to 31 million patients, a "remarkable achievement
for a care arrangement that was scarcely on the map at all two years
ago," according to a report released Nov. 26 by management consulting
company Oliver Wyman.

Cigna's collaborative accountable care program includes 42 participating
entities, mostly large, with about 10,000 physicians providing care for
400,000 members. A paper in the November Health Affairs found the plan's
ACO program improved quality and lowered costs.



Practice Perspectives on Payer Performance, 2012

For the fifth year in a row, the Medical Group Management Association
(MGMA) has conducted its poll to determine group practice professionals'
attitudes about payer interactions.

Of the payers who are willing to engage in innovative payment models
(accountable care, shared savings, medical homes or payment bundling),
how favorable or unfavorable do you consider these options to be to your

Rating average / Payer

1.68 Medicare Part B
1.62 United Healthcare
1.62 Aetna
1.58 Cigna
1.57 Anthem
1.55 Humana
1.48 Coventry

(Based upon a 5 point scale where 1 = Completely unfavorable, 2 =
Moderately unfavorable, 3 = Neutral, 4 = Moderately favorable, and 5 =
Completely favorable.)



Health Affairs
November 2012
A Collaborative Accountable Care Model In Three Practices Showed
Promising Early Results On Costs And Quality Of Care
By Richard B. Salmon, Mark I. Sanderson, Barbara A. Walters, Karen
Kennedy, Robert C. Flores and Alan M. Muney

Cigna's Collaborative Accountable Care initiative provides financial
incentives to physician groups and integrated delivery systems to
improve the quality and efficiency of care for patients in commercial
open-access benefit plans.

Although not statistically significant, these early results revealed
favorable trends in total medical costs and quality of care.


Comment: These early results should sound the alarms on our current
efforts to implement accountable care organizations (ACOs). We've barely
begun and already about 30 million patients have been assigned to ACOs.
Yet look at how that is working.

Health care professionals in group practices were polled on how
favorable or unfavorable the insurers' innovative payment models,
primarily ACOs, were to their practices. The average rating for all
insurers was in the 1s - "completely unfavorable"!

Further, we are now seeing the same response from the insurers that we
did with earlier efforts at managed care. They were telling us then that
we were receiving higher quality care at lower cost. As it turned out,
costs continued to rise and quality remained mediocre.

Now Cigna is reporting that the recent Health Affairs article that they
authored showed that their "ACO program improved quality and lowered
costs." Yet the article actually states that these early results were
"not statistically significant."

This turkey has already taken off, and yet it can't fly. The health care
of 30 million patients is already at stake, and they are being cared for
health care professionals who find the arrangement COMPLETELY UNFAVORABLE!

No comments:

Post a Comment