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I appreciated all the dialogue that my recent post on KevinMD’s blog, “The emergency department in an ACO world,” has generated over the past week or so – the number of comments is a great indicator that ED physicians are not just letting this topic go by. I’ve compiled the following post to address as many as I can:
For this week’s guest post we welcome back Joel C. Hoffman, Senior Vice President with OptumInsight Payer Solutions.
Evaluating and managing population risk has traditionally been the payer’s role in the health care system. But as providers become increasingly accountable for populations, they will need to be equipped with many of the same competencies that payers have been relying on for years. This includes the right technology to capture both clinical and claims data, but also the ability to analyze and transform these data into actionable information that affords the delivery of high quality, efficient health care and ultimately real population health — that’s where actuarial services come in.
There’s a reason why actuaries are known for incessant number crunching, data collection and manipulation (along with the occasional pocket protector) — it’s a complicated field that first requires extensive training and then plenty of experience to practice effectively. Our team of over 175 actuaries, who are engaged on a daily basis to do this work, are hearing excitement, but also understandable caution from providers looking to assess and understand both the risk and the financial benefits of setting up any of a variety of accountable care models. Many providers — including some already approved for the more advanced CMS Pioneer ACO — just don’t know where to begin, so we’ve pulled together these tips for how to wear the “payer hat” when evaluating populations and assessing risk:
This week, Bill Miller – OptumInsight EVP responsible for provider strategy and solutions – explains why Sustainable Health Communities are both possible and probable in the years ahead as guest blogger for Healthcare-Exchange.
The buzzword du jour in healthcare is “Accountable Care Organizations”, or ACOs. The cynics among us might ask “Weren’t we calling these ‘medical homes’ just a few short months ago?” Those with long memories in addition to that dose of cynicism hark back twenty years and say these are just capitated HMOs.
The term is hardly what’s most important as the healthcare system evolves in response to healthcare reform, ARRA meaningful use, spending cuts, increasing regulation and a myriad of other influences, many of which are beyond the control of the hospital community. What matters is the outcome, the building and operation of what we at Ingenix refer to as Sustainable Health Communities.
