ACOs digging in to stay, experts say

WASHINGTON – The message was loud and clear at the Third National Accountable Care Organization (ACO) Summit in Washington, D.C., June 6-8. ACOs of today are not like the bygone HMOs of the 1980s. The new ACOs are backed by advanced healthcare IT this time, and an even greater urgency to contain costs that will keep them around, speakers said.

Several speakers commented on the momentum under way.

Marilyn Tavenner, acting administrator for the Centers for Medicare & Medicaid Services (CMS) in a keynote on June 7 said the past two years have been exciting. "It's interesting to see dialogue move from 'change is needed' to 'what type of change is needed?'"

"Since we started doing these conferences three years ago, there has been a huge uptake," said Mark McClellan, MD, director of the Engelberg Center for Health Care Reform, Brookings Institution and former CMS Administrator.

Now, the healthcare industry is dealing with the practical issues of establishing ACOs. "We're much more focused today," he said. "The actual challenges are in large-scale implementation and how to overcome them."

Deficit reduction politics is anticipated to color every decision in Washington, following the election this fall, McClellan said. If the Republicans win the White House and overturn the ACA, the pressure "will only go up" for them to do something to lower healthcare costs.

"The choices will be not if this will happen, but how well it will happen," McClellan said, of healthcare payment reform, including ACOs. There is not much more that can be done to "squeeze down" on Medicare fee-for-service. "Whatever happens [in the upcoming election], pressure to use ACOs will be bigger than ever," he said.

McClellan also said if the Supreme Court decides in June to revoke healthcare reform, CMS still has enough existing authority to establish ACOs.

Elliott Fisher, director of Population Health and Policy at the Center for Population Health, The Dartmouth Institute for Health Policy in Lebanon, N.H., attributed the growing ACO trend to positive outlook and early signs of success. The Medicare Shared Savings program is actually saving money, Fisher said. Energy has started to emerge in early ACO pilots. "All it takes is one positive deviant, and everyone else starts to follow," Fisher said.

For those physicians who are still skeptical, Fisher said the improved care ACOs can give to patients will draw them in. Physicians will be assisted to make wise decisions and patients will be well-informed, Fisher said.

In the past, patients thought savings was coming at their own expense, McClellan said. ACOs will prove to them it will be different this time.