New Provider Payment Models & Delivery Systems (ACOs, PCMHs, etc.)

ACO partnerships and quality collaborations with health plans could be vital to maintaining a reasonable risk profile and an overall cost effective population health management. Reform’s uncertainty is unlikely to curtail general ACO formation that seems to “have a life of its own” and is proceeding nationwide. To improve outcomes at lower cost, enhance clinical interaction, and bundle payments, more providers will consider new care delivery structures and reform-defined governance of ACO/PCMH’s and incentives. The future will see healthcare evolve from an uncoordinated, encounter‐based system to structures that are more accountable, reliable, patient‐centered and quality‐based. Questions remain within new value‐based payment models as to how to ensure that strong, robust patient‐centered primary care remains a foundation of ACOs – which may define a “middle ground” for both legislators and healthcare stakeholders. Health plans will need to help address the financial implications of ACO’s (MLR’s, insurance risks, shared savings, etc) and gain agreement on quality and cost/efficiency measures.