Is an ACO Another Name for an HMO? New White Paper
[This blog post introduces the fourth installment of HealthStream's new Accountable Care Organization (ACO)-focused white paper series. As the fourth of eight sponsored papers, it describes how ACOs may have a role among future health plan choices.]
What do we need to know about health plans and ACOs for 2012? The most important thing is knowing the new healthcare terminology for communicating within the marketplace. We no longer talk about preferred provider organization (PPO) or health maintenance organization (HMO) or exclusive provider organization (EPO) but now we use terms like accountable care organization (ACO) or patient-centered medical home (PCMH) or post-acute care or alternative care model. Even the word “capitation,” which brought fear to providers and consumers alike, is back but has been softened by such terms as financial incentives, or value-based contracting, cost efficiencies, or population risk management. We now utilize terminology from the 60s, not peace and love but collaboration, partnership, accountability, unified, and coordinated as we connect the healthcare organizations with patients. Let’s not forget information technology (IT) which is not health information technology (HIT) or exchange (HIE).
In 2012 and Beyond, Health Data (and Using It) is Power!
The second most important thing for 2012 will be that data is power. The healthcare organizations that learn how to effectively use (analytics), measure (provider and patient outcomes), and implement (evidence-based and predictive modeling) this information into their processes will gain a competitive edge in the marketplace for many years to come.
The Importance of Health Plan ACO Partnership Initiatives
Since the 2010 passage of the Patient Protection and Affordable Care Act (PPACA), industry, media, and national interest has grown in the concept of the Accountable Care Organization (ACO). Most of the recent press releases have been focused on Medicare’s initiatives on developing ACOs as part of the Shared Savings Program3 and Pioneer ACO4 demonstration projects. What hasn’t gotten a lot of attention has been the various health plan ACO partnership initiatives that have been taking place throughout the country. The health plans are currently replacing less-risk bearing product lines such as a preferred provider organization (PPO) with an ACO-like product in hopes of increasing the value they receive for the prices they pay by lowering the cost of care, improving health status, and integrating the continuum of care.
This white paper features:
- A compendium of the current ACO marketplace by state and sponsor
- Health Plan Initiatives involving ACOs
- ACOs, Alternative Care Models, and Health Plan Partnerships
- A Private Market ACOs Roundtable Q&A
Download the white paper.