Speech-language pathologists and audiologists who want to join one of the 27 recently selected accountable care organizations (ACOs) may want to begin investigating how to participate in these fledgling organizations.
The Centers for Medicare and Medicaid Services (CMS) announced on April 10 the first 27 ACOs to participate in the Medicare Shared Savings Program. The selected organizations have agreed to improve care through better coordination among providers—while reducing the costs of care—so they may share in the savings to Medicare (see "Rules Issued for Accountable Care Organizations," The ASHA Leader, December 20, 2011).
SLPs and audiologists will have opportunities to join an ACO. It's important for interested professionals to investigate how their local ACO is building its network, how quality standards are set and reviewed, and how they can become ancillary service providers, advises Janet Brown, ASHA director of health care services in speech-language pathology.
"Every ACO is configured differently," Brown said, "so it's worthwhile for clinicians to contact their local ACO now to inquire about the network's standards and procedures for inviting providers to participate in the ACO." In the present model, Brown says, SLPs will continue to deliver services and will be reimbursed on a fee-for-services basis—but they could still benefit from shared savings in the future by aligning themselves with an ACO's growing network.
How Shared Savings Work
Created as a provision of the Affordable Care Act, the Shared Savings Program encourages providers of Medicare-covered services and supplies, including physicians, hospitals, and others involved in patient care, to create a new type of health care entity—an ACO. Each ACO agrees to be held accountable for improving people's health and experiences with health care, while reducing the growth rate in health care spending.
Studies have shown that better care often costs less, because coordinated care helps ensure patients receive the right care at the right time. The goal is to avoid unnecessary duplication of services and prevent medical errors. All ACOs that succeed in providing high-quality care—as measured by performance on 33 quality measures relating to care coordination and patient safety, use of appropriate preventive health services, improved care for at-risk populations, and the patient experience of care—receive a share of the savings to Medicare.
Case Study: Arizona Connected Care
Arizona Connected Care—an ACO of more than 150 independent physicians, three health centers, and the Tucson Medical Center—was launched in November 2011, and continues to build its network of physicians, hospitals, and ancillary service providers.
The organization seeks to engage patients in decisions about their own care, a goal designed to improve decision-making, quality of life, and use of community health resources. Arizona Connected Care is re-focusing on basics, providing patients with information and extra resources to assist with transitions between care settings, such as hospital and home—and ensuring that patients with chronic conditions receive appropriate care in the optimum setting. The ACO expects to serve almost 7,500 beneficiaries.
According to Lorraine Glazar, director of provider relations for Arizona Connected Care, three shareholder groups have ownership of the ACO: physicians, hospitals, and ancillary service providers. The network is roughly 70% physician-owned, although it has not yet begun to add ancillary providers. To aid in the selection of ancillary service providers, the company is setting internal quality standards and building a database that will rate providers' quality and efficiency. By investing in care coordination, the organization aims to reduce hospital admissions and re-admissions, a major source of high health care costs.
To determine the best steps to take, Glazar advises, "SLPs and audiologists who are interested in ACO participation should investigate how they're configured. Talk to them now."
Quality and Efficiency Measures
The Affordable Care Act is being reviewed by the U.S. Supreme Court, and a decision is expected in June. But regardless of whether the Court upholds the act, many of its provisions—like the creation of ACOs—have already been set in motion.
"These provisions signal a paradigm shift in health care," Brown says. "In the future, all providers, including SLPs, will need to demonstrate their quality and efficiency."
A new ACO may or may not have contracts in place with Medicare or other insurers, and many continue to phase in new providers. But because each ACO's performance will be assessed according to established quality measures, clinicians must be able to make a case that their services demonstrate quality and increase the function of patients in ways that prevent re-admissions or reduce medical costs.
In addition to contacting an ACO to learn its policies and practices, Brown urges clinicians who wish to join an ACO to cultivate relationships with primary care physicians, preferably those already in the ACO's network.
"This contact helps to establish the referral patterns an ACO may use to determine an ancillary provider's suitability for inclusion in the network," Brown says. "SLPs should advocate for themselves now, while ACO networks are still expanding, to gain a portion of savings in the future."