Answer: When they form an industry association!
Back in February, a group came together for form a national association for ACOs(NAACOS) to, according to the announcement press release, promote the growth of the model, industry standards, best practice sharing and vendor engagement. What was missing from the press release was fixed on the web site which adds as goal #2: “Participate with Federal Agencies in the development and implementation of public policy”. In other words: lobbying. And, of course, as the model evolves from Medicare to commercial and Medicaid populations, state level policy will also need to be factored in. Earlier this week, Florida saw the formation of a state association of ACOs – the Florida Association of ACOs (FLACCOs) – with thirteen organizations.
The public policy agenda is real, of course. Key issues described at the initial conference for NAACOS in a presentation by SNR Denton include:
- Sequestration: how does the 2% cut affect the ACO benchmark? Is it applied to the amout of savings shared?
- Quality performance benchmarks: How to manage ill-defined and “unattainable” targets?
- How do adjust the benchmarks in the face of new providers, geographic-specific events, changes in payment policies
Improperly handled, these issues could gate the growth and impact of ACOs. A coordinated approach on what would work best for providers would be a helpful contribution.
However, ACOs should be cautious about the inertia an industry association can inadvertently create by seeking to protect the interests of its membership:
- The ACO model is still evolving and not every ACO being stood up today will – or should – survive. There may be trade-offs between protecting the interests of some ACOs (e.g. encouraging CMS lenience on one "unattainable" performance measure) vs. what policy direction will best enable provider accountability to improve healthcare (even on what today might appear to be unattainable goals)
- Also, the ACO community is smaller and more fragmented relative to many of the vendor community seeking to serve it. It will be important to make sure the association remains focused on the impact ACOs can deliver (which in the end will fuel or gate their growth) rather than what works best for incumbent vendors.