ACO NEWS from THE MAX

Editor’s note: The following news has been compiled by Major Accounts Exchange (The MAX), healthcare’s leading provider of real world intelligence for the supply chain. The MAX serves as a Supply Chain “Community” where senior-level executives can easily Find, Digest, and Act on vital business and market intelligence. For the latest news impacting the supply chains of over 1,200 IDNs and all the GPOs, visit www.uslifeline.com


New CMO to lead Summa Health physician group, ACO
Summa Health (Akron, OH) named Matthew Wayne as new CMO of its physician group, Summa Health Network (Akron, OH), and its Medicare ACO, Summa NewHealth Collaborative (Akron, OH). Wayne previously served as CMO of the CommuniCare Family of Companies (Blue Ash, OH).

Catalyst partners with Methodist Patient Centered ACO
Catalyst Health Network (Plano, TX) and Methodist Patient Centered ACO (MPCACO) (Dallas, TX) entered a new collaboration agreement. MPCACO joins Catalyst’s list of affiliated healthcare organizations. The organization will work with Catalyst’s independent physician network to enhance delivery of higher quality care while improving overall costs. MPCACO is affiliated with Methodist Health System (Dallas, TX).

Humana, MercyRockford Health create ACO
MercyRockford Health System (Rockford, IL) and Humana Inc (Louisville, KY) established a new ACO to serve Humana Medicare Advantage members throughout northern IL. The agreement, effective May 1, 2015, includes value-based incentives tied to performance improvement and supports successful population health management and a “world-class” patient experience for Humana members and Rockford Health System patients in northern IL. The ACO will offer more personalized care and a broad range of population health tools like predictive analytics, chronic care, disease management, and wellness programs.

Lancaster General Health forms ACO with Humana
Lancaster General Health System (LGH) (Lancaster, PA) formed an ACO with Humana Inc (Louisville, KY) to manage the care of roughly 3,000 Medicare Advantage members in Lancaster County. Under the ACO, participating LGH physicians will coordinate care for Humana members and partner with the insurer on chronic care, disease management, and wellness programs in an attempt to improve outcomes and lower costs. The ACO includes value-based incentives tied to clinical performance and efficiency. The model became effective in early April 2015.

CMS: Medicaid proposes new quality and performance measures
CMS (Baltimore, MD) proposed a “modernization of Medicaid managed care regulations,” for the first time in a decade. CMS’ new proposal has a three-pronged focus: enhance consumer protection, develop better care coordination, and enable delivery system reform. The regulations will shift the appeals process and the level of enrollee information dissemination to practices seen in Medicare Advantage and the private market practice, reduce the administrative burden on regulators and plans that offer different products in different coverage programs, use advances in electronic communication to accelerate information exchange, adopt the medical loss ratio (MLR) that currently applies to Medicare Advantage (85:15 ratio) while making some accommodations for state-specific concerns, strengthen states’ capacity to use financial incentives to reward managed care plans that meet quality measures, and develop a quality-rating system. Critics of the revisions are concerned that an arbitrary cap on the health plans’ administrative costs could undermine critical services, such as transportation to and from appointments, social services, and more. CMS is soliciting public comment on the proposed rule through July 27, 2015.

National ACO, RISARC partner to create data-driven management infrastructure
National ACO (Beverly Hills, CA) and RISARC (Burbank, CA) formed a partnership for RISARC to manage National ACO’s accountable care organization. The collaboration will allow for the creation of a customized, comprehensive, data-driven management infrastructure to optimize performance in the Medicare Shared Savings Program (MSSP). National ACO will be able to access analytic tools and population management metrics which will help provide a model for quality, cost, and patient care. No financial details were disclosed.


HCA North TX becomes affiliate member of Catalyst Health Network ACO

HCA North Texas (Irving, TX) became an affiliate member of the Catalyst Health Network (Plano, TX), an ACO for independent physicians in North Texas. The HCA Holdings Inc (Nashville, TN) branch brings its dozen hospitals, 11 freestanding surgery centers, five freestanding EDs, and 31 urgent care centers into Catalyst’s network. The network now comprises 175 providers throughout the region. According to Catalyst officials, the addition of HCA provides an opportunity for Catalyst’s independent physicians to better coordinate care and create a more dynamic healthcare platform for independent physicians.

Northwestern Physician Partners, Aetna form ACO
Northwestern Physician Partners (Winfield, IL), the medical group of Northwestern Medicine (Chicago, IL),formed an ACO with Aetna Inc (Hartford, CT). The agreement covers 5,600 Aetna members and 550 physicians. Under the ACO, Aetna nurse coordinators will help participating physicians manage patient care and reduce preventable hospitalizations and readmissions through better disease management and preventative care. Physicians will also be eligible for additional reimbursement if they meet quality and cost targets.

River Health ACO partners with Health Quality Partners to enhance preventative care
River Health ACO (RHACO) (Harrisburg, PA) partnered with Health Quality Partners (HQP) (Doylestown, PA) to implement the advanced preventive care program for central Pennsylvania Medicare beneficiaries with advanced chronic conditions. The program will focus on patients with heart failure, coronary heart disease, diabetes, and chronic lung disease. It seeks to eliminate unnecessary hospitalizations that arise from inadequate medication management, poor self-care routines, and insufficient communication among multiple providers. The program will help beneficiaries improve health habits and live more independently while reducing costs. River Health ACO is a joint venture between PinnacleHealth System (Harrisburg, PA) and Susquehanna Health System (Williamsport, PA).

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