It is not clear how an accountable care organizations comprised of independent providers can implement and finance necessary administration systems, according to a report from actuarial and consulting firm Milliman.
The increasingly challenging environment for individual providers and ACOs is not a novel observation, but Milliman researchers have concluded that for emerging systems, a partnership with a health plan will be more attractive than becoming an ACO serving Medicare fee-for-service beneficiaries.
A health plan and provider partnership offers the following benefits for providers, according to the report. A health plan can:
• provide administrative and financial support until the ACO is organized and able to assume those functions;
• serve as an intermediary between the ACO and beneficiaries, leading to fewer legal and organizational difficulties in sharing expenses and allocating financial risk;
• encourage or require member compliance with ACO care coordination and cost management;
• and provide meaningful financial upside for continued improvement by all ACOs through contracts, including those that have already reached efficiency.
Read the Milliman report on health plan and provider partnerships (pdf).
Related Articles on ACOs:
Private Payors May Not Use Medicare Template for ACOs
6 Areas of Start-up Costs for ACOs
Should Your Hospital Form an ACO? 5 Considerations
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