Medicare ACO Regs Out While Private Sector Surges

October 21, 2011
|In Policy & Health Reform, Provider Relations, Strategy, ACOs
|By GHG Advisors

CMS released the final Medicare ACO Shared Savings Program regulations yesterday after taking a beating in over 1,200 industry comments on the draft.  Let’s hope they made some big changes, as Medicare is in danger of being left in the dust as ACOs surge forward in the commercial sector. 

Population-wide accountable care partnerships (ACPs) are moving rapidly in dozens of states, largely driven by the big national and regional health plans. There are now 50 multi-payer ACPs across the U.S. plus 151 medical home partnerships, AHIP disclosed at a Summit on Shared Accountability in DC this week.

 

Aetna has created a company-wide organization whose entire focus is on integrating ACOs into all products and services . The HealthPartners Total Cost of Care system is now applied to two-thirds of its members, Wellpoint’s multi-payer Medical Home model is expanding beyond California and New York with emerging evidence of its success, and Blues plans in Massachusetts, New Jersey and Maryland are moving forward with their own commercial ACO initiatives. Ten large national and regional health plans gave an update on how fast the ACO concept is exploding.

By contrast, the Medicare ACO program has been quiet as CMS toiled away on a rewrite of the regs, with the final rules out yesterday but relatively little interest emerging beyond the Pioneer ACO Demonstration finalists — and many of them are still tentative pending review of the new final rule.  All 7 of Gorman Health Group’s applicants for Pioneer were selected — but they’re not necessarily in yet.  CMS’s recalcitrance on considering partial and global capitation models for Pioneers is tamping down our clients’ enthusiasm as we’re told capitation isn’t operationally feasible for CMS until Year 3 of the demo.  If the final reg isn’t a dramatic improvement over the “fart in church” draft regulation in March, I worry that CMS will be left at the altar as payers and providers seek less burdensome opportunities in the commercial and Medicaid markets. 

Watch this page for our take on the final regs.