At today’s meeting of the state’s Payment Reform Commission consensus began to emerge about some ACO Framework issues while diverse opinions were voiced on others. Consensus is emerging around ACO core capacities and the arrangements with primary care and specialty physicians; the former should (with only certain exceptions) be a member a single ACO, specialists can be in multiple ACOs. There is consensus that consumers need to be able to seek care outside the ACO (a position the Alliance has supported), with the ACO responsible for these costs – except in circumstances of out of state care or catastrophic need.
Obligations of ACOs to include and be accountable for a broader range of services beyond primary acute inpatient care are still being debated. The Home Care Alliance has submitted and made comments at meetings that in order for ACOs to avoid creating (or recreating) a hospital-centric, ‘siloed’ system of care, the qualifying criteria must include a capacity for coordinating care across primary, acute and post acute services. This capacity could be in an integrated model, or in a more virtual manner, but the later (virtual model) should be required to be constructed with strong performance based contracts or other explicit arrangements for care across the continuum. The position for not mandating a broad continuum of services is espoused by members of the Committee who advocate giving ACOs broad flexibility in terms of scope of services for which they are responsible. A limited scope of responsibility, they argue, might encourage more early interested parties. Secretary Bigby expressed a position that the ACO must be responsible for an assigned patient’s total health, which would argue for having a full continuum of services.
The meeting ended with some discussion of ACOs having an unintended consequence of changing the market in ways that certain essential community services (ER’s, public health programs) are lost. This was acknowledged but with little resolution.