From Volume to Value: ACOs and Value-based Care
From Volume to Value: ACOs and Value-based Care From Volume to Value: ACOs and Value-based Care From Volume to Value: ACOs and Value-based Care From Volume to Value: ACOs and Value-based Care From Volume to Value: ACOs and Value-based Care From Volume to Value: ACOs and Value-based Care
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Version 3.3, June 12, 2017.

The health care marketplace has always been dynamic, but with the rapid rise in alternative payment models in recent years, health care executives must understand the move from volume to value—and the opportunities that are arising from the evolving health care delivery marketplace.

From Volume to Value: ACOs and Value-based Care is a complete overhaul of our original ACO Outlook report first launched in 2014. In this extensive report, we provide key insights into the world of accountable care, bundled payments and other value-based health care delivery models. ACOs and Value-based Care is informed by primary research from November 2016 with Darwin's ACO Executive Panel, as well as trends gleaned from our earlier ACO leadership surveys.

ACOs and Value-based Care is packed with original research and insights you won't find anywhere else. See below for a detailed table of contents.

This report is designed for executives in the following market segments:

  • Pharma/biotech and medical device market access executives
  • Integrated health systems, physician groups and ACOs
  • Retail and wholesale pharmacy
  • DME and medical supplies
  • Home health, home care, hospice, and post-acute providers
  • Health services researchers
  • Payers and other providers
  • Private equity and venture capital investors

ACOs and Value-based Care consists of a printed, wire-bound document plus a downloadable .pdf, 310 pages, including a 24-page executive summary and 89 figures and tables. Subscribers will receive periodic updates in .pdf format for one year from the date of purchase.

Purchasers of either a Department or Global Site License will receive a 90-minute, in-person Q&A with Darwin Health CEO John Marchica. Please contact service@darwinhealth.net for more information.

ACOs and Value-based Care is part of a larger syndicated research effort. Partners interested in participating in this ongoing project have the opportunity to get specific questions answered, tailoring the report to their needs. Please contact us if you are interested in diving even deeper into value-based care and alternative payment models.

 

Contents

Executive Summary 

 

Chapter 1: Introduction

 

Chapter 2:  Value-based Care Models

1. Value-Based Care Defined

2. Medicare ACO Models

- Pioneer Model

- Medicare Shared Savings Program

- Advance Payment ACO Model

- ACO Investment Model

- Next Generation ACO

- Comprehensive ESRD Care (CEC) Model

- Newest Medicare ACO Models

- “Vermont receives federal approval for statewide all-payer ACO"

3. Other Value-based Care Models

- Medicaid ACOs

- Commercial ACOs

- Employer-led ACOs

- Employer-driven bundles

- Patient-Centered Medical Homes

4. Innovation Center Initiatives: National

- Bundled Payments for Care Improvement (BPCI) Initiative

- Comprehensive Primary Care Initiative (CPC)

- Community-based Care Transitions Program (CCTP)

- FQHC Advanced Primary Care Practice Demonstration

- Independence at Home Demonstration

- “Independence at Home: A Success Story”

- Home Health Value-based Reimbursement Pilot

- Nursing Home Value-Based Purchasing Demonstration

5. Innovation Center Models: State

6. Innovation Center Models: Local

7. Issue Brief: The Oncology Care Model

8. Issue Brief: The Cardiac Care Bundle

9. Issue Brief: Understanding MACRA

10. Issue Brief: Value-based Contracting in Pharmaceuticals

 

Chapter 3: 2016 ACO Executive Survey

1. Research Focus

2. Methodology

3. ACO Characteristics

4. Results

A. 2017 Initiatives

B. Reducing Readmissions

C. Patient Data Management

D. Issues Affecting Cost and Quality

E. Relationships with Suppliers and Providers

F. Relationships with Pharmaceutical Companies

5. Summary

 

Chapter 4: Influential ACOs

1. Advocate Health

2. Arizona Care Network

3. Atrius Health

4. Baylor Scott&White Quality Alliance

5. Beacon Health LLC

6. Beth Israel Deaconess Care Organization

7. Carolinas HealthCare System (Triad Health Network)

8. Dartmouth-Hitchcock

9. Memorial Hermann

10. Ochsner Accountable Care Network LLC

11. Optimus Healthcare Partners

12. Partners HealthCare

13. Physician Organization of Michigan

14. UCLA Health ACO

 

Chapter 5: Performance

A. Quality

- Medicare ACO Quality Metrics

- MSSP Average Quality Scores, 2013-2015

- Pioneer Average Quality Scores, 2012-2015

- Quality Metrics

1. Patient/Caregiver Experience

2. Preventive Medicine

3. Readmission Rates

4. SNF Admissions

5. Unplanned Admissions for Patients with Diabetes

6. Unplanned Admissions for Patients with Heart Failure

7. Unplanned Admissions for Patients with Multiple Chronic Conditions

8. COPD or Asthma Admissions

9. Heart Failure

10. Meaningful Use

11. Diabetes Composite

12. Overall Quality

B. Financial Performance 2015

C. Aggregate Financial Performance 2015

D. Bundled Payments

 

Chapter 6: Implications for Suppliers

1. Pharmacy

2. Pharmaceuticals and Biotechnology

3. Medical Device Providers

4. Durable Medical Equipment

5. Home Health Care

6. Ambulatory Care

7. Long-term Care

8. Other Providers and Suppliers

 

Chapter 7: Market Outlook

1. Issues and Opportunities

2. Critical Success Factors

 

Conclusion

 

Appendices

A: Innovation Awards

B: Original list of Pioneer ACOs

C. Convening Organizations

D: BPCI Participants and Convener Definitions

E: Darwin Health ACO of the Year Awards

F: Initial ACO Executive Survey Results

 

Figures

Figure 1.1 U.S. Population Growth Projections, 2015-2050

Figure 1.2 Weekly Closing Share Price: Astra Zeneca, Pfizer, GlaxoSmithKline, Novartis and Amgen

Figure 2.1 MSSP home office locations

Figure 2.2 Advance Payment ACO locations

Figure 2.3 Medicare Shared Savings Program locations

Figure 2.4 Home Health VBR Pilot Outcomes and Process Measures

Figure 3.1 Panel Distribution by Title: C-level Group

Figure 3.2 Panel Distribution by Region

Figure 3.3 2017 Initiatives: Behavioral Health, Alzheimer’s and Dementia

Figure 3.4 Factor Importance in Reducing Readmissions

Figure 3.5 EHR Usage in Practice

Figure 3.6 ACO Executive Concerns

Figure 3.7 Issues Affecting Quality of Care

Figure 3.8 Issues Affecting Ability to Control Costs

Figure 3.9 Existing Relationships with Suppliers and Other Providers

Figure 3.10 Exploring Relationships with Suppliers and Other Providers

Figure 3.11 Has a Simple Contract in Place

Figure 3.12 Has a Risk-based Contract in Place

Figure 3.13 Provider/Supplier Contracting 2014-2016

Figure 4.1 Advocate Health Care Value-based Initiatives

Figure 4.2 Advocate Physician Partners Accountable Care Visual Scorecard

Figure 4.3 Dignity Health Value-based Initiatives

Figure 4.4 Arizona Care Network Visual Scorecard

Figure 4.5 Atrius Health Value-based Initiatives

Figure 4.6 Atrius Health Pioneer ACO Visual Scorecard

Figure 4.7 Baylor Scott&White Value-based Initiatives

Figure 4.8 Baylor Scott&White MSSP Visual Scorecard

Figure 4.9 Beacon Health Value-based Initiatives

Figure 4.10 Beth Israel Deaconess Value-based Initiatives

Figure 4.11 Beth Israel Deaconess Pioneer ACO Visual Scorecard

Figure 4.12 Carolinas HealthCare System Value-based Initiatives

Figure 4.13 Triad HealthCare Network MSSP Visual Scorecard

Figure 4.14 Dartmouth-Hitchcock Value-based Initiatives

Figure 4.15 Dartmouth-Hitchcock Pioneer ACO Visual Scorecard

Figure 4.16 Memorial Hermann Value-based Initiatives

Figure 4.17 Memorial Hermann MSSP ACO Visual Scorecard

Figure 4.18 Ochsner Health System Value-based Initiatives

Figure 4.19 Ochsner Accountable Care Network MSSP Visual Scorecard

Figure 4.20 Optimus Healthcare Partners Value-based Initiatives

Figure 4.21 Optimus Healthcare Partners MSSP Visual Scorecard

Figure 4.22 Partners HealthCare Value-based Initiatives

Figure 4.23 Partners HealthCare Pioneer ACO Visual Scorecard

Figure 4.24 Physician’s Organization of Michigan Value-based Initiatives

Figure 4.25 POM ACO MSSP Visual Scorecard

Figure 4.26 UCLA Value-based Initiatives

Figure 4.27 UCLA Faculty Practice Group MSSP Visual Scorecard

Figure 7.1 Big Data in Health Care

Figure 7.2 Factors Affecting Readmission

Figure 7.3 The Patient-Reported Outcome-Quality of Life Tool

Figure 7.4 Prevalence of heart disease, hypertension, stroke and cancer among adults aged 65 and over

Figure 7.5 2016 Executive Survey—EHR Usage

 

Tables

Table 2.1 Pioneer ACO Status at Program End

Table 2.2 Pioneer ACOs: What happened to the dropouts?

Table 2.3 Payment Characteristics

Table 2.4 MSSPs By Region

Table 2.5 Advance Payment ACOs

Table 2.6 Investment Model ACOs

Table 2.7 Next Generation ACOs

Table 2.8 Pioneer vs. Next Generation ACO

Table 2.9 ESCO Participating Providers

Table 2.10 Medicaid Program Structure

Table 2.11 Top Convening Organizations 

Table 3.1 Sample Characteristics

Table 3.2 Factor Importance in Reducing Readmissions

Table 3.3 Simple Contracting, 2014-2016

Table 3.4 Risk-based Contracting, 2014-2016

Table 3.5 ACO Contracting by ACO Model

Table 5.1 Medicare ACO Quality Metrics

Table 5.2 MSSP Average Quality Scores, 2013-2015

Table 5.3 Pioneer Average Quality Scores, 2012-2015

Table 5.4 Top Decile MSSP ACOs, Patient/Caregiver Experience

Table 5.5 Top Decile MSSP ACOs, Preventive Medicine

Table 5.6 Top Decile MSSP ACOs, Readmission Rates

Table 5.7 Top Decile MSSP ACOs, SNF Admissions

Table 5.8 Top Decile MSSP ACOs, Unplanned Admissions for Patients with Diabetes

Table 5.9 Top Decile MSSP ACOs, Unplanned Admissions for Patients with Heart Failure

Table 5.10 Top Decile MSSP ACOs, Unplanned Admissions for Patients with Multiple Chronic Conditions

Table 5.11 Top Decile MSSP ACOs, COPD or Asthma Admissions

Table 5.12 Top Decile MSSP ACOs, Heart Failure

Table 5.13 All ACOs with 100 percent Meaningful Use Attestation

Table 5.14 Top Decile MSSP ACOs, Diabetes Composite

Table 5.15 Top Decile MSSP ACOs, Overall Quality

Table 5.16 MSSP ACOs with the Highest Earned Shared Savings

Table 5.17 MSSP ACOs with the Largest Losses

Table 5.18 MSSP ACO Financial Performance, 2013-2015

Table 5.19 MSSP ACO Performance per Beneficiary

Table 5.20 Pioneer ACO Financial Performance, 2013-2015

Table 5.21 Pioneer ACO Performance per Beneficiary

Table 7.1 Telehealth Private Insurance Coverage

Table 7.2 Cost Comparison of Medical Procedures, 2006 (U.S. dollars)