A new Health Affairs report found that management organizations can become partners in accountable care organizations (ACOs) to help providers, especially those not connected to hospitals, share risk and provide expertise in areas like financing, managing complex patients and data management.
The report found 37% of ACOs studied had a management partner. Two-thirds of those ACOs said the partner shared in financial risks or rewards.
The researchers used data from 2013-2015 to analyze 276 ACOs from the National Survey of Accountable Care Organizations to understand how many non-provider management partners were involved in ACOs, what services they provided and what the structure of those ACOs was.
The report found that ACOs with partners used data services provided by the partner (94%), received administrative services (87%), received educational services (68%) and received care coordination services (66%). Partners in half of those ACOs provided all of those services.
The study authors said the ACOs with partners were more likely to be primary care providers. The organizations that partnered with providers included national companies like Valence Health, Walgreens and Caravan Health and local groups like Florida Accountable Care Services and MedChi.
Though these situations are an option for ACOs, the researchers said the performance on costs and quality in Medicare ACO programs were not better than ACOs without partners. The researchers also warned there could still be potential issues concerning how physicians and partners share savings. These partnerships need “guidance, transparency and protection,” especially given that ACOs management partners are unregulated, according to the report.
The report said federal and state policymakers and payers may need to take into account the role that management partners are playing in ACOs. States, private payers and Medicare could also provide technical expertise and data infrastructure. “For example, incentives might be used to support smaller physician groups and those in rural areas that lack the resources for needed management and infrastructure capabilities,” the researchers said.
Though partnering organizations can assist providers in ACOs, the study said more research is needed to better understand the partnerships and potential positive or negative consequences.
Providers are increasingly moving into value-based contracting, ACOs and alternative payment models (APMs). Private payers see value-based care as an improvement over paying for volume and the federal government, through models like MACRA, is also placing an emphasis on ACOs and value. That’s the goal, but how to get there is still a question.
The Health Care Transformation Task Force recently released a comprehensive analysis of high-performing ACOs to help determine successful structures and strategies.
Many ACOs have found success. The CMS recently found that 11 of 18 Next Generation ACOs earned savings in 2016 and overall cut gross Medicare spending by $836 million last year, including $70.6 million in net savings returned to the Medicare Trust Fund.