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San Diego Out the Gate on ACOs

Reforming California’s health care delivery system will require providers and payers to integrate and coordinate their activities to improve quality outcomes and lower costs in Medicare, Medicaid and private coverage.

Accountable care organizations (ACOs) could be one successful mechanism to do just that. An ACO generally is a group of health care professionals that has the legal structure to receive and distribute payments, provide care coordination, invest in infrastructure and redesign care processes, and reward high quality and efficient services. In essence, they are teams of providers that manage and coordinate care for patients across different care settings to improve outcomes and share the savings. Ideally, they would partner with health plans to help budget resources globally and aggregate performance data.

For more on ACOs, read this recent ITUP report. For more on other delivery system reforms and new payment/organizational models, read this ITUP report.

ACOs in the ACA

The Accountable Care Act (ACA) includes incentives to encourage the creation of ACOs in Medicare and Medicaid, including the Medicare Shared Savings Program and a five-year Medicaid pediatric ACO demonstration project starting January 1, 2012. Under these programs, if the ACO meets established performance guidelines and savings, the members receive a portion of the savings as an incentive for successful collaboration and coordination.

ACOs Emerging in California

On Monday, a coalition comprised of a health plan, medical group and medical center announced plans to launch a pilot ACO in San Diego.

The pilot, a joint effort of Anthem Blue Cross of California, Sharp Community Medical Group and Sharp Rees-Stealy Medical Centers, will be available to individual, small- and large-group policyholders in the San Diego region who receive the majority of their care from physicians associated with Sharp HealthCare.

In their press release, the trio stated that in the ACO, the physician becomes a true partner in working with the patient on his/her overall health, with enhanced focus on preventive care and chronic care management.