ACOs Rapidly Expanding Across States

Online, April 27, 2014 (Newswire.com) - Accountable Care Organizations began forming in the last quarter of 2010. Growth has been steadily increasing by about 30-40 most quarters, with huge upswings occurring towards the end of 2012 and the end of 2013. After 3 years, a total of 606 ACOs have been formed, including both Medicare and Medicaid. Leading the pack by number of ACOs per state is California with 58, followed closely by Florida with 55. Additionally, as of the most recently created ACOs in December 2013, ACOs are now in all states including the District of Columbia.

There are many different ACO models, demonstrations, and innovations. ACOs can take on different names in different states such as Coordinated Care Organizations (CCOs) or Care Coordination Entities (CCEs). Some states take more of a regional approach to capitation. Some states merely updated their current managed care contracts. Some are converting their Medicaid and/or Medicare contracts to ACOs. Some states provide choices such as per-member per-month or shared savings. Some states are piloting 3 year demonstrations. Some states are reimbursing based on quality measures while other states are reimbursing based on cost reduction, while others are using a combination approach.

The move toward ACOs is a result of the Affordable Care Act (ACA). The ACA is focused upon achieving better patient quality outcomes, in more efficient ways, while reducing healthcare costs. The ultimate goal and painful transition is from fee-for-service to fee-for-value - shifting from volume to value and quantity to quality. This shift requires organizations to change corporate culture, increase coordination of care, and embark on infrastructure changes, just to name a few. This change cannot happen overnight. As such, the ACA has provided stepping stones in the pursuit of pay-for-value in the form of new delivery systems such as bundled payments and Accountable Care Organizations. Implementing these new delivery systems can be very cumbersome.

BHM understands this shift in risk and how the ACA affects providers, payers, and government entities. No matter what stage your organization is in as it relates to ACOs from contemplation to implementation, BHM can provide assistance and make the transition much easier. BHM has assisted many organizations as they transform to both Managed Care Organizations (MCOs) and Accountable Care Organizations (ACOs). BHM's ACO conversion services assist organizations in effectively and efficiently making the shift to Accountable Care with sustainable solutions that cushion the financial impact off conversion and work to maximize margin growth. BHM's conversion process consists of:

• Conduct a readiness assessment to help identify gaps

• Assign dedicated ACO project managers and the latest project management tools to create an implementation plan for conversion success

• Provide a team of dedicated financial strategists who will work on maximizing revenue strategies both during and after conversion

• Follow up with post implementation assessments which put the power of clinical, financial, and quality data in your hands.

BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including healthcare transformation assistance, strategic planning and organizational analysis, accreditation consulting, financial consulting for healthcare, physician advisor/peer review, and organizational development.