Tuesday, March 13, 2012

Accountable Care Organizations and Work Comp

As we begin to see early (and encouraging) signs of success from Accountable Care Organizations (ACOs) around the country, I wonder what promise this might hold for work comp.

In Illinois, Chicago-based Advocate Health Care has teamed with Blue Cross Blue Shield of Illinois to deploy an ACO that appears to be yielding solid results. According to Kaiser Health News, the ACO has led to a 10.6% drop in inpatient admissions and a 5.4% drop in ED visits over the first 6 months of 2011. These data points exceeded the reduction in utilization across the rest of BCBS's book of business in Illinois.

Success factors? "Key to the results were the hiring of 60 'care managers,' many embedded in physician practices,  to manage high-risk cases and post-acute care. Also important are a relatively narrow provider network, anchored by Advocate’s 10 hospitals and about 4,000 physicians, and a payment system that incentivizes Advocate to contain costs but doesn’t put it at risk of catastrophic loss, said Dr. H. Scott Sarran, BCBSIL’s chief medical officer."

Case management and a tight, well-managed network... where have I heard that before?

These are the same strategies that many in work comp have tried to leverage to get a hold on utilization... but to no avail. So what's the difference?

In the ACO model, the case management is driven from the provider's perspective, not the insurer's. In the ACO model, there are real financial incentives embedded for network performance - its not simply fee for service delivered through a select group of providers. And finally, patients bear some level of financial responsibility for their utilization of resources within the ACO.

What needs to happen for us to see this model in work comp?

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