Medicare, schmedicare

Don’t forget who you work for. According to Dr. Poonam Alaigh, former Acting Under Secretary of Health at the Dept of Veterans Affairs, “Medicare covers only 14% of all Americans with insurance, where half of Americans receive their health insurance benefits through their employer.” In a recent article she states “With employers in the drivers’ seat, this year is going to be an interesting one to watch for value-based purchasing arrangements.” What is value-based pricing? Not this (mild language, very funny). We’d start with this video from Harvard professor Michael Porter or this one from Humana. Dr. Poonan references three models becoming more popular with employers: Implementing Bundled Payment Approaches, Adopting ACO models, and Adopting Employee Incentives. With stats like “as of 2016 large self-funded employers offering bundled programs realized cost savings of 20-30% per case” it’s time for employers to step-up.

Growing, growing, relevant

You know what grew at almost the same rate (up ~24%) as the DJIA in 2017? The number of ACOs operating in the US. For the uninitiated, “Accountable Care Organizations (ACOs) are groups of health care providers, who come together to give coordinated care to Medicare patients. When an ACO succeeds in delivering high-quality care and spending health care dollars more wisely, it shares the savings it achieves for the Medicare program.” There will be 18% more ACOs in 2018, than in 2017. There are 5 different ACO models and according to a report by IQVIA (form required), there are “1,000 federal, commercial and Medicaid ACOs, representing an estimated 28M beneficiaries.” The report lists the top 30 ACOs as well as the top ACOs in each of the 5 models. Not sure, but ~9% of the US population starts to raise an eyebrow or one.

Hawking says no to NHS ACOs

NHS England is considering plans to create accountable care organizations responsible for uniting various health services in a region. The idea is being put forth as a way to encourage teamwork across clinicians at those various services, which would ideally translate into better health outcomes for patients. But critics like Stephen Hawking are concerned that this is a slippery slope into healthcare privatization, and so they’re taking UK Health Secretary Jeremy Hunt to court. They allege there’s no legal basis for NHS England to go through with its plans, and it would take an act of Parliament to make it above-board. This is all happening in the midst of NHS budget cuts which led thousands to march in London on Saturday. Y’all alright NHS?

It was my understanding there would be no math

On your next commute, look around. According to recent research by Leavitt Partners, 1 of every 10 Americans (that’s 10% for the math challenged) is now covered by an Accountable Care Organization (ACO). What is an ACO you ask? Read this. There are now 923 public and private ACOs operating in the US, covering more than 32 million lives. ACOs were created to share in the savings they create for Medicare patients and if you want to dig deeper, here is a list of 110 ACOs “you need to know” complied by Becker’s Hospital Review. As ACOs grow, so will their negotiating power and influence. All we are saying is “keep an eye on it” and don’t let the math (Chevy Chase clip) stand in the way.