More House Anarchy = Likelihood of Government Shutdown
So a week ago the conventional wisdom was that the prospects of an extremist-induced government shutdown on October 1 were infinitesimal. Not anymore. Must. Stop. Underestimating. Wingnuts.
The House was scheduled to vote Wednesday on a bill to fund the government after September 30. Right-wing extremists have been demanding that the House refuse to continue funding the government unless Senate Democrats and President Obama agree to defund Obamacare. Rational Republicans in both House and Senate have pleaded that this approach is doomed and would damage the GOP brand to force a shutdown. To mollify the wingnuts, Speaker Boehner instead hatched this whopper: let's pass continued government funding -- attached to a separate bill defunding Obamacare, which of course can be surgically excised in the Senate.
But some extremists are still saying defund-Obamcare-or-else, and it takes less than 20 of them to defect to cause Boehner serious problems. This is what gives this tiny, noisy cabal big leverage.
The vote delay means several things:
- A government shutdown is much more likely now. With funding expired on September 30, the calendar is not our friend. One Republican aide privately raged to the New Yorker of the extremists, "They're screwing us."
- Boehner's plan would continue government funding, but would lock in sequestration across-the-board cuts to domestic programs, while likely easing cuts on the Pentagon in light of the Syria mess. This approach virtually ensures Boehner won't get a single Democratic vote, and therefore, Boehner needs every last wingnut out there.
- Debt ceiling hostage-taking now appears more likely, too. The big "bait and switch" of the year has been Boehner trying to dissuade the extremists on their government shutdown strategy on one hand, while offering another go at defunding ObamaCare with the debt ceiling. The problem is we're now going to hit the ceiling in mid-October, two months earlier than expected, and the calendar just effectively called Boehner's bluff. Hence, the new approach of punting ObamaCare defunding to the Senate. Another default on the debt would be disastrous for the economy, but that didn't stop the wingnuts two years ago. House leaders don't seem to have a clue how they'll handle the debt ceiling now.
Another Pound of Flesh for Government Health Programs This Fall?
With summer drawing to a spectacular close here in Washington, it's abundantly clear that the "train wreck" everyone's expecting won't involve the launch of ObamaCare, but rather an epic legislative pile-up in Congress. With the collision of the debate on Syria, the immigration bill tearing the GOP apart, and now a near-concurrent exhaustion of government funding and the debt ceiling at the end of September/early October, the President and Speaker Boehner will be picking up the pieces of their agendas come Halloween. The question is whether government-sponsored health programs will have to give up another pound of flesh in the process.
Congress returns from summer recess Monday, and it'll be all about Syria, and that will crowd out other Congressional priorities like immigration, continued government funding for the new fiscal year, and the positive bipartisan progress made on the long-awaited "doc fix" for Medicare fee-for-service physician payment rates.
Funding for the government expires on September 30, 2013. You'll recall that earlier this summer, a right-wing cabal led by Senator Ted Cruz (R-TX) threatened to use continued government funding as leverage to defund ObamaCare. While they don't have nearly enough votes in either House or Senate, they made enough noise for Speaker Boehner to try to mollify them. The GOP leadership pitch was "don't shut down the government over ObamaCare, that'll kill us in public opinion. Let's use the debt ceiling as leverage at year-end instead." But now the government is expected to hit the debt limit by mid-October, two months earlier than expected, so the calendar just called Boehner's bluff with his right wing.
All of this will erupt in late September and Boehner will have to punt. We expect a 6-12 week extension of government funding to the latter part of the year, and certainly no "grand bargain" with the President. In the meantime, capital markets will be a panic for months given uncertainty over continuing government operations and US credit ratings. So this whole noisy mess will drag on toward the holidays, right while ObamaCare's exchanges are launching.
While this is happening, the basic outlines of the last budget meltdown, the loathed across-the-board spending cuts called "sequestration," will remain in place. Syria raises the potential that sequestration is eased for the Pentagon so we have plenty of bombs and missiles on hand. Sequestration's cuts to domestic programs, and therefore the impact to Medicare and Medicaid, are likely to remain in place. But the Pentagon will need its pound of flesh, and Medicare and Medicaid are always at risk as the biggest contributors to the deficit. If this happens, we suspect Congress will get it in the form of higher beneficiary out-of-pocket costs like deductibles and physician copays.
The biggest casualty of this legislative train wreck may be the doc pay fix. Congress made significant bipartisan progress on the Medicare physician payment fix of the flawed "sustainable growth rate" formula which will cut 30% in 2014 unless offset. While the cost of a long-term fix was recently reduced (~$150B vs. $300B) and raised hopes for a deal, it will now get thrown into this latest manufactured budget disaster. This is significant for Medicare Advantage because a long-term doc fix means MA rates go up about 6-7%; no fix, no boost. So, ironically, physicians and beneficiaries could end up helping pay for bombs and missiles aimed at Syria, and plans may not get the very positive ripple effect of a doc pay fix. Sigh.
So, our prediction: punts on continued government funding and the debt ceiling until the holidays; a noisy, messy launch of ObamaCare exchanges; panicked global markets as this budgetary kabuki theatre act drags out; and physicians and beneficiaries extorted.
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No matter what delivery system arrangement you currently have, or what course you intend to pursue, GHG can help. Visit out website to learn more.
Gorman Health Group Senior Vice President of Public Policy Jean LeMasurier, summarizes the final rule from CMS regarding exchange functions, eligibility for exemptions, and miscellaneous minimum essential coverage provisions.
Join us on Oct. 1 and hear Gorman Health Group's Chief Sales and Marketing Officer, RaeAnn Grossman, outline the components of a successful risk-adjustment program.
What a Difference a Year Makes
Since the passage of the Medicare Modernization Act, Gorman Health Group has been discussing the value that Medicare Advantage (MA) and Prescription Drug Plans (PDP) offer to both public sector and private sector employers for their Medicare eligible retirees. The value proposition includes FASB/GASB benefits as well as more affordable coverage. A number of employers have moved their retirees to these plans over the last seven years. Some employers contract directly with a MA plan or PDP plan while other employers offer their retirees a choice of plans through a private exchange such as Extend Health. This has been a gradual movement. However, during the last year, the shift has been very dramatic. CMS enrollment data for August 2013 show that employer group enrollment in PDPs was 4.4 million which is more than double the 2 million employer group enrollment in August 2012. Employer group enrollment in MA plans increased to 2.6 million in August 2013 compared to 2.4 million enrollment in August 2012.
One of the drivers of the PDP enrollment has been the repeal of the Retiree Drug Subsidy tax benefits in 2013. The repeal provided an opportunity for private sector employers to review their coverage of retiree drug benefits and many concluded that the PDP was the best choice for both the employer and the retirees. We expect this shift to MA and PDP plans to continue as more employers are moving their retirees to private exchanges. The Wall Street Journal reported on September 9 that Time Warner has joined IBM in shifting retirees to Extend Health which is owned by Towers Watson & Co. to choose a Medicare plan. Extend Health offers MA plans, PDPs and Medigap supplemental plans. According to the Journal, Extend Health has 300 companies that use their private exchange and that one third of these employers joined this year.
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We can help your PDP develop and implement efficient and compliant internal operations and prepare effectively for CMS audits with professional services and unmatched compliance tools. Visit out website to learn more.
Join us on Oct. 1 and hear Gorman Health Group's Chief Sales and Marketing Officer, RaeAnn Grossman, outline the components of a successful risk-adjustment program.
Agent Oversight Opportunities
The leaves will soon be changing, a sign of renewal. It sounds cliche, but I don't know where this year has gone. There has not been much opportunity to stop and smell the roses while they were still in bloom! CMS has been busy and so have we.
I had the pleasure of addressing a group of compensation experts representing quite a few Blues plans in the very hospitable city of Jacksonville, Florida last week. I would link to the conference or the materials, but most likely it is hidden from us in the uber-exclusive BlueWeb extranet of the BCBSA. Many thanks to Glen Ross and company for having us!
Agent Oversight was my topic of choice, since AEP is coming as quickly as those leaves will be changing. Plan Sponsors are deep into marketing strategies, material preparation and (hopefully) systems updates and re-training to gear up for what hopes to be a successful AEP. I addressed two areas of agent oversight and provided some guidance and best practices for some common misses.
The first opportunity addressed pertained to Outbound Enrollment Verification, or OEV. You wouldn't believe what a hotbed this is for unnecessary beneficiary cancellations. Many call center representatives are not always asking the additional questions to determine if their script information doesn't jive with what a sales agent told a beneficiary. For example, the CMS model script makes no mention of Low Income Subsidy nor how it would affect a potential member's out-of-pocket costs. I provided quite a few recommendations and best practices to the group, including the recommendation to customize the model script and submit for 45-day review, and to have sales staff provide OEV information after the enrollment form is completed. The beneficiary should know what the next step is in the process, and there's nothing like a heads-up about the next phone call from the health plan to reenforce the commitment to member-centric service.
The next area of opportunity pertains to some common misses in the sales allegation investigation process. A comprehensive investigation is not only reactive to allegations, but it also incorporates proactive steps to reduce future occurrences of the same issue. Lack of documentation is at the heart of some common failures. We've seen at times there is no one central repository for investigation notes. Interviews are not conducted in a timely manner, which begs the question, where do sales allegations fall on a priority list? We know there's a ton of work to be done to maintain agent information to ensure they are appointed appropriately; we handle it in Sales Sentinel. However, the relationship with the agent is an ongoing process. Plan Sponsors should communicate to agents that allegations are going to be a part of doing business. The sky will not fall upon receipt of one. What matters most is the outcome of that investigation, and taking steps to ensure future occurrences are avoided.
Regional Offices are keeping a close eye on outlier plans by reviewing calls to 1-800-MEDICARE, aka Complaint Tracking Module (CTM) calls. Not only are they looking for outliers in overall CTM volume, but they are reviewing percentages of marketing misrepresentation cases within. If they are appearing there, most likely they are appearing in Customer Service inquiries and not being identified and handled as grievances. My presentation on these two opportunities for oversight, as well as best practices, can be found here on the Point. Not a member yet? Sign up here or contact us for group rates.
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We created Sales Sentinel™ specifically to meet the needs of health care organizations operating in regulated government markets. Whether you operate within MA or the new Health Insurance Marketplaces (the Exchanges), Sales Sentinel offers a suite of solutions.
Listen as Senior Director of Product Operations at Gorman Health Group, Alex Keltner discusses GHG's Sales Sentinel, the solution to train, credential and onboard your sales force.
Bloom Marketing Group's call center is licensed in 48 contiguous states and offers marketing, call center and technology solutions to the healthcare industry. Bloom is a proud partner of Gorman Health Group, click here to learn more.
Call Center Metrics Reporting Should Be Robust and Actionable
Metrics reporting is as important to insurance call centers as the Law of Large numbers is to an actuary. Call centers use metrics reporting on sales and marketing campaigns to measure individual agent performance, track campaign results and more.
Sales and marketing metrics reporting should be robust and dynamic because you can't manage what you can't measure. Dynamic reports should cover all required CMS call center metrics as well as standard call center Key Performance Indicators (KPIs), call dispositions and marketing metrics at the individual toll-free number level. This in-depth reporting creates a true measure of cost per response, cost per lead, and cost per sale.
No matter how robust the reporting however, metrics are useless if they are not actionable. At minimum standard reports should include key performance indicators that allow you to take action. Examples include:
- Abandonment Rate, Drop Rate — length of time caller waited before they abandoned the call and the percentage of overall calls that were dropped. Look at these numbers daily at a minimum and ensure your call center is not missing opportunities through abandoned and dropped calls.
- Average Handle Time, Wrap-Up Time — the average time an agent spent with a caller during the call and in "wrapping up." Make sure your call center Managers are examining these items closely and coaching team members who fall outside the norms on these metrics to keep your center working at peak efficiency. Look for opportunities to streamline your processes in these metrics, too.
- Average Time in Queue — the average time callers waited before being connected to an agent. Look at this metric daily and in aggregate to ensure you aren't losing opportunities with your callers by keeping them on hold.
- Disposition Reporting — a summary of what happened on the call such as "Enrolled" or "Mailed Materials." Examine these closely daily and in aggregate to gain insight into the overall campaign outcomes.
- Quality Reporting — how agents scored on each call based on a client's metrics and/or metrics created by the call center. Bloom uses a minimum of 13 variables plus 9 pass/fail compliance variables when grading agent performance. Look at these reports individually and collectively to identify gaps in caller understanding, opportunities for training, and occasions for scripting improvement.
Are the reporting metrics received from your call center clear and actionable?
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The Bloom Call Center is licensed in 48 contiguous states and offers marketing, call center and technology solutions to the health care industry. Since 2007, Bloom has participated in over 55 million conversations about insurance products, submitted over 200,000 applications for insurance, and set over 150,000 appointments for seniors to meet with Licensed Agents. Bloom is a proud partner of Gorman Health Group. Click here to learn more.
Variation in ACA Premiums
ACA premiums have been a key topic of discussion this month as more state marketplaces and companies released proposed and final rates for QHPs or "qualified health plans" that will be available on October 1. As discussed in an earlier blog, ASPE released an analysis of rates in July from 10 mostly state based marketplaces that showed premiums will be 10 — 18 percent lower than CBO estimates. Subsequent releases show that premiums will increase in some markets, for example Ohio and Florida, as plans move to more comprehensive "essential health benefit packages". Rates for plans in the federally facilitated marketplaces will not be released until September.
The Alliance for Health Reform held a meeting on ACA premiums entitled "Rate Shock or Not" that discussed the reasons for some of the premium differences. These include variations by age, smoking, cost sharing differences, network size and provider reimbursement rates, level of competition, an active vs. passive Marketplace, the ability of Medicaid managed care companies to build on discounted provider payments, the presence of a dominant hospital system, insurer size and experience in the individual and small group markets. There is also a lack of data on current premiums in the individual market and the health status of the uninsured that make pre and post ACA comparisons difficult.
Joel Ario et al wrote an interesting Health Affairs blog that provided some additional insight on the wide variation in premiums that they called "startling". They cite a 76 percent difference in premiums between the second highest silver plan and second lowest silver plan in New York and only a 3 percent difference in San Francisco. They cite a number of reasons that premiums vary so much: actuaries are working in the dark, similar to Part D plans are willing to bid low in the first year to acquire members, plans sponsors are not all the same (e.g. some plans have more narrow networks or more generous drug benefits) and active purchasing works.
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Health plans operating within the Exchanges must evolve from a culture of sales and marketing to a culture that is member-centric and more accountable with a greater sense of urgency. GHG can help, find out how.
From sales and marketing to staff training, data management and reconciliation, GHG Founder & Executive Chairman John Gorman breaks down each potential roadblock and offers tips and suggestions on how to keep your organization moving on the right path before the launch of the Exchanges, in this recording from the 2013 GHG Forum.
Big News: A Health Care Cost Indicator Went *DOWN*. AGAIN!
The national average bid for Medicare Part D drug coverage is going down, again. Since 2011, the average bid has declined every year. The amount of each year's reduction, compared to the prior year, has ranged from 1.4% in 2011 to 5.8% in 2013. The 2014 decrease of 4.7%, fits the pattern. So why, you ask, is the price of Medicare drug coverage going down? And especially why is it going down at a time when drug plans are being required to fill in more of the coverage gap (aka "donut hole") each year?
First, a detour to discuss the donut hole, the gap between coverage of routine prescriptions and catastrophic coverage: The Affordable Care Act includes a provision that requires Part D plans to fill in the hole for generic drugs, by covering 7% more cost each year, until they cover 75% by 2020. Meanwhile, manufacturers of brand name drugs will offer increasing discounts on their products until the cost of brand drugs for people in the "hole" is only 25% of retail. At that point, coverage in the hole will be equal to coverage before a beneficiary falls into the hole, with beneficiaries paying 25%.
So, all other things being equal, we would expect to see bids increase each year to fund the added cost of this annual 7% increment in coverage in the coverage gap. In addition, the Affordable Care Act imposes a fee on all insurance companies, starting in 2014, to help fund the premium subsidies for low income enrollees. This fee, which is a fixed dollar amount that is pro-rated among insurance companies based on their relative premiums, will fall more lightly on Part D plans, due to their relative low premiums compared with comprehensive health insurance. But it still represents an added cost that one would expect to flow through to the bid.
The logical conclusion, since the average bid went down instead of up, is that all other things are not equal.
Since the average bid was announced, there has been considerable speculation about what's happening. Here's my guess. First, remember that the national average bid is a weighted average, and so reflects the bids submitted by the behemoths of the industry. The small guys' bids essentially don't count. It's logical to conclude that the big guys are continuing to improve their ability to wring more price concessions from both manufacturers and drug chains.
Second it's just possible that medication therapy management (MTM) is beginning to make significant inroads into the cost of total drug therapy. Or, since the bids represent plans' expectations about 2014 costs, it's at least possible that plans expect MTM to make significant inroads.
Third, it's possible that more of the total cost of the program is being transferred to the federal government through the reinsurance payments for catastrophic coverage. More on that in a minute.
And, finally, 2014 is the year that the 85% floor on medical loss ratios goes into effect for Medicare drug plans. If a plan is running a lower loss ratio, it will need to refund money to the government if it carries the low loss ratio into 2014. A low loss ratio is no longer a mark of success. Faced with a potential refund to Uncle Sam, the most profitable plans may have concluded it's better to reduce their premium to achieve the minimum loss ratio floor, and use the lower premium to gain a market place advantage. Of course, if everyone has done this, they are really just avoiding the loss of market share.
Curiously, while the average bid has gone down every year since 2011, the base beneficiary premium has gone up in three out of those four years. The base premium is used to calculate the subsidy payment from Medicare to Part D plans. The subsidy is the average bid minus the base premium. The base premium is 25.5% of the average bid, adjusted to account for the expected payments from Medicare to plans to cover the catastrophic reinsurance segment of the Part D benefit. When a beneficiary exits the donut hole due to cumulative prescription costs above the upper bound of the gap, Medicare pays 80% of any additional drug costs. The calculation of the base premium is adjusted to compensate for these payments, in a way that varies the base premium in proportion with changes in expected catastrophic payments. As these reinsurance payments increase, the base premium increases. That is what we have seen in three of the past four years, meaning that the costs to Medicare of the catastrophic component are going up faster than the average bid is going down. Since Medicare pays 80% of these costs, and plans only pay 15% (members pay the rest), an increase in catastrophic, above-the-donut-hole, claim expenses will be borne disproportionately by Medicare, which would be consistent with slower increases, or absolute decreases, in the average bid. That is, more of the total cost of the benefit package is being shifted to Medicare from the Part D plans due to this catastrophic reinsurance provision. But increasing the base premium reduces the subsidy to the plans, since the subsidy is the average bid less the (higher) base premium.
Whatever is behind this, it's been a trend since 2011, and this year's result shouldn't be surprising in that regard. Three conclusions suggest themselves:
- Part D plans will get paid less because the average bid is less, and because the base premium that is deducted from the average bid is greater;
- It's going to be tougher for small plans to compete with big plans, if the main driver of low bids (and lower subsidies as a result) is better price negotiation due to bigness; and,
- Herb Stein's law will eventually overwhelm whatever else is going on.
Stein's law, which is becoming my favorite response to criticisms of Medicare, and the general ill humor of the governing classes these days, says that "If a thing cannot go on forever, it will stop."
So take heart. And, if you are a Medicare beneficiary, enjoy your lower premium.
Resources
The rapid changes to Part D regulations make the tracking and implementation of these CMS requirements exceptionally difficult -- to say nothing of actually managing to them. Find out how GHG can help.
In 2013, GHG Forum attendees went on a detailed walk-through of Part D rejected claims including frequency, sampling, data validation and documentation. Learn what CMS was looking for in past audits, and what plans need to do differently when filing 2013 audits.
Navigating through the maze of Part B versus Part D coverage can be difficult. See how GHG Senior Consultant, Sharon Durfee, breaks down the differences between Medicare Part D and B.
State Marketplace Variation
The Alliance for Health Reform held a briefing entitled "Health Insurance Marketplaces: Different Strokes for Different States". I think the title was an apt description of all the variation that is going on in states that are implementing their own Marketplaces. In many ways, it looks like a natural experiment. Sarah Dash of the Georgetown University Health Policy Institute (CHIR) highlighted some of the different approaches states are taking which are discussed in more detail in a recent report by Urban and CHIR. For example, 4 states are choosing to selectively contract with a limited number of plans, 6 states are serving as a market organizer by limiting the number or type of plans and 8 states are allowing all plans who meet standards to participate. Three states and DC required insurer participation. Maryland for example is requiring that insurers above a certain size in both the individual and small group market must participate in their Marketplace. Five states are setting "waiting periods" for insurers who decide not to participate during the first year. Six states aligned coverage inside and outside their Marketplaces to minimize adverse selection. 8 states and DC are requiring additional coverage levels beyond silver and gold. Six states required insurers to offer standardized plan designs ranging from 3 plans in Oregon to 17 in California and 7 states and DC required plans to be meaningfully different.
States are ahead of the federal requirements in several areas, for example, the federal regulations will require quality reporting in 2016, however 9 states are displaying quality measures the first year and 10 states are developing state-specific quality rating systems. Most states are providing employee choice options on the SHOP, while the federal marketplace has postponed employee choice until 2015. Some states have released plan premiums. Sara Collins from the Commonwealth Fund discussed a recent analysis by ASPE in HHS that found the proposed individual silver plan premiums in 2014 range from 10 — 18 percent lower than CBO estimates. Premiums in the federal marketplace will not be released until September.
Joseph Thompson, the Surgeon General for the State of Arkansas, discussed the state's premium assistance waiver program where the state plans to send 225,000 uninsured low income residents to private plans in the Marketplace rather than expand their Medicaid program. The state is hopeful that enrollment in the same QHPs that serve the commercial population will improve payment and delivery of care. Under the plan the state will send low income persons that are not medically frail to the Marketplace to select a QHP. The state has been developing a standardized self-assessment screening form and estimates that about 10 percent of the uninsured will be determined frail and be referred to the Medicaid fee for service program while the rest will be served by the Arkansas Marketplace.
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Listen as GHG Senior Consultant, Donna Burtanger, discusses sales and marketing capabilities in the upcoming Health Insurance Marketplaces (Exchanges). Learn the three most important items customers participating in the Exchanges look for in a potential health plan, and how to ensure you are marketing to the correct demographic.
Health plans operating within the Exchanges must evolve from a culture of sales and marketing to a culture that is member-centric and more accountable with a greater sense of urgency. GHG can help, find out how.
From sales and marketing to staff training, data management and reconciliation, GHG Founder & Executive Chairman John Gorman breaks down each potential roadblock and offers tips and suggestions on how to keep your organization moving on the right path before the launch of the Exchanges, in this recording from the 2013 GHG Forum.
The survey says...
In May, GHG conducted several marketplace surveys. The initial survey highlighted our clients' top priorities. Here is what the ranking showed as our clients' focal points:
- STARS
- Clinical & Financial Alignment
- Risk Adjustment
- MLR monitoring
We understand that in order to emerge as leaders or at least survivors of the rate reduction and complex regulatory world we live in, health plans, health systems, ACOs, and capitated medical groups have to identify business levers that impact the greatest improvement to the bottom line. This is exactly why we created the Alignment Innovation Suite - we take your data and create a driver and alert system for an interdisciplinary team to review and discuss. The Alignment reports clearly indicate where the problems are and where we can jointly create the road map to fix them.
The new Alignment engine couples medical cost and utilization while at the same time overlays benefit and network design. The reports display the areas in the greatest need of collaboration and redesign, i.e. where to spend your time and resources to get the best bang for your buck.
In recent GHG case studies, the Alignment engine, assessment and reports clearly depict the need to 1) redesign provider payment models, 2) completely restructure health services or medical management functions and criteria to impact population health management & patient engagement , 3) operational improvements; simple changes with huge financial impacts and 4) benefit remodeling to improve patient navigation of your healthcare ecosystem.
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GHG's Alignment Solution Suite assessment is backed by industry leading health care expertise and is managed by a team of veteran consultants who will help lead your organization to better financial alignment, product design and health care efficiency. Visit our website to find out more.
Join us on August 8 to get practical advice on the best ways of getting into the MA market from GHG Chief Development Officer, Aaron Eaton, Senior Vice President of Finance, William A. MacBain, and Senior Director of Compliance Solutions, Regan Pennypacker.
ACOs: Here to stay or gone tomorrow?
With the recent announcement by CMS that nine of the 32 Pioneers were dropping out of the program there has been much "Sturm und Drang" about the passing of ACOs into obscurity. A recent article in the Investor Business Daily has gone as far as to predict that not only are all ACOs going to fail, but while in existence they "will diminish the quality of care received" by Medicare patients.
Seriously? Is anyone buying this stuff? Think about it. The program, Pioneer and MSSP, has improved beneficiary access to services, and allowed better coordination of services. This is achieved by ensuring that patient information is shared among caregivers, which improves joint decision making between a care giver and the patient about treatment options. If it all goes according to plan, there should be a reduction in the cost trend because the elimination of unnecessary procedures or treatment results in less "stuff" to charge for. But even if savings do not materialize, isn't the prospect of earlier diagnosis and better treatment outcomes just as good of a result?
Interestingly enough, I do not recall any of the Pioneers who dropped out suggesting that they would stop their efforts at coordinating care or encouraging joint provider patient decision-making, etc.
What's the point you ask? The point is that the underpinnings of the Pioneer and MSSP programs, i.e. providing the right services in the right setting at the right time for the right price, will survive the ACO and will serve as the legacy for all who participated in the program --stay or leave.
Those of us in the healthcare industry committed to the improvement of clinical outcomes while curtailing costs see ACOs for what they are. ACOs are one small step for service delivery engineering, and one giant incentive for continued health care practice reform at the provider and payer level.
So let's stop wasting energy speculating whether, and or when ACOs disappear. The more important question is how do we build on the foundation that CMS has created with the Pioneer, MSSP and other demonstration programs designed to elicit service delivery and pricing innovations. Opportunity knocks.
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If conceived and executed well, the ACO represents a unique opportunity for provider organizations to redefine their financial relationships with payers, beginning with Medicare. Read more on ACO opportunities in our white paper on the topic
Join us on August 8 to get practical advice on the best ways of getting into the MA market from GHG's Chief Development Officer, Aaron Eaton, Senior Vice President of Finance, William A. MacBain, and Senior Director of Compliance Solutions, Regan Pennypacker.
Our comprehensive management solutions provide ACOs in transition with the tools, processes, and expert guidance to drive overall performance through new models of finance, leadership, and clinical value. Visit our website to learn more.