Are ACOs here to stay? I clearly recall the question I received in the physician meeting in the fall of 2015. It was a skeptical question about the longevity of ACOs as the conduit to bring about change. Would ACOs be just another trend that would come and go like previous efforts to contain costs? Well there I was, just six months into the job, and as confident as I could be I explained how the momentum around value had strong bipartisan support and whatever the model, there would be plenty of work for us to do collectively to address cost and quality concerns. But maybe inside I was not sure myself. Now it is five years later and the ACO model and the number of payers engaging with us continues.
Results across the nation are improving, with the recently announced Medicare Shared Savings Program savings for 2019 topping $2.6 billion for the 11 million seniors served in the program. Results at the NHN are improving as well, and after all our shared savings are known for 2019, we will easily top the $6 million we earned in 2018.
But what about now? Will the pandemic be the thing that brings down the ACO model as physicians and hospitals refocus their efforts on sustainability? Early indications say no, and that value-based efforts will accelerate. Why? A key reason is that economic conditions will intensify pressure to contain costs as businesses look to remain viable. Afterall, rising costs are what led to the passing of the Affordable Care Act and the birth of the ACO model. And, a drop off in medical services due to the pandemic has emphasized the need to diversify by augmenting fee-for-service (FFS) income with VBC revenue streams. Performance data will show that as fee-for-service payments dropped off, savings in bundled payment and shared savings programs remained high and those providers in capitated payment programs experienced less financial impact due to declining services. And at the NHN, we are excited that some primary care clinics within Nebraska Medicine will transition to CMS’ new Primary Care First program, using capitated population-based payments as a baseline for reimbursement. So while the pandemic has disrupted traditional care and impacted revenue, it has solidified the need for value-based care. So five years later I still believe that yes, ACOs are here to stay.
