Susan Morse

McKesson and Blue Cross Blue Shield of Arizona are partnering to create a new service that helps physician practices that may not be part of a value-based network take on risk as traditional accountable care organizations do. The service, dubbed ACO Partner, is not an accountable care organization. But don't call it a product either, said John Wallace, ACO Partner's new president and chief operating officer. Wallace is McKesson's national vice president and general manager of accountable care services. "It's more of support structure," Wallace said, for the physician practices and providers that need help making the transition to performance reimbursement. It works like this: Physicians and providers sign a shared savings contract with a health plan participating within ACO Partner. Through the services provided, the practice reduces its expenses in medical claims in general, and a percentage of that savings goes back to the provider and insurer, according to Wallace. There is no cost to practices, so they share in the savings without risking payment cuts. "We're making the bet to say, 'Let's do it for them.' We're taking on the responsibility of analytics," Wallace said. So far, only Blue Cross Blue Shield of Arizona has signed on. [See also: McKesson launches venture capital fund.] ACO Partner in marketed to independent physicians who may not have the resources to transition to value-based care, and also to ACOs and clinically integrated networks that may need help accelerating the transition to getting paid for high quality and cost effective healthcare. "Better benefits for lower costs," Wallace said. "It allows them to take more market share, to compete at a higher level." McKesson provides the technology infrastructure and the analytics to support payers as they collaborate with the provider networks. ACO Partner claims to help physicians with the practical components of value-based care, including disease management, care management, population health management and patient engagement. Providers and payers contracting with ACO Partner have access to  strategic management, analytics, population health, technology, network development, physician engagement and care management services. "A lot of ACOs are making heavy investments in services and technology without a clear roadmap for success," Wallace said. A year from now, Wallace wants ACO Partner to have three to five health plans participating in state of Arizona. Beyond Arizona, he envisions the model in multiple other states. For patients, the new entity is intended to strengthen outcomes while helping reduce out-of-pocket expenses, Wallace said. "Providers love it because they have a better patient experience," Wallace said. "Plans love it because they're seeing a higher quality of care delivered. And it extends to a more efficient cost structure." Twitter: @SusanJMorse

As physicians study the Merit-based Incentive Payment System and Advanced Alternative Payment Models outlined in the newly proposed MACRA rule, the Centers for Medicare and Medicaid Services has released its finalized Quality Measure Development Plan in support of the new payment structure.

In the first major overhaul of Medicaid managed care requirements in more than a decade, the Centers for Medicare and Medicaid Services published new rules on April 25 that affect how Medicaid works for the nearly two-thirds of beneficiaries who get their coverage through private managed care plans. It aligns key rules and practices with those of marketplace and Medicare Advantage, including the addition of reporting medical loss ratio to Medicaid to ensure managed care plans focus on delivering care, not profits, CMS said. The rule finalizes a medical loss ratio at 85 percent. Insurers must spend at least 85 percent of their Medicaid revenue on medical care to improve quality. The remaining 15 percent may be spent for administrative reasons such as salaries and marketing, CMS said. Health plans that don't meet the goal will face future penalties in having their state rates lowered. On the health information technology front, the rules encourage – but don't require – commitment to the principles of health information exchange "Health information technology and the electronic exchange of health information are important tools for achieving the care coordination objectives proposed," according to the final rule. HHS "supports the principle that all individuals, their families, their healthcare and social service providers, and payers should have consistent and timely access to health information in a standardized format that can be securely exchanged among the patient, providers, and others involved in the individual’s care," it states.   "Further, the Department is committed to accelerating health information exchange through the use of health IT across the broader care continuum and across payers. Health IT that facilitates the secure, efficient and effective sharing and use of health-related information when and where it is needed is an important contributor to improving health outcomes, improving health care quality and lowering health care costs." Specifically, the rule points to ONC's Nationwide Interoperability Roadmap and 2016 Interoperability Standards Advisory as containing the "best available standards and implementation specifications to enable priority HIE functions." Providers, payers, and vendors are encouraged to take them into account "as they implement interoperable HIE across the continuum of care, including care settings such as behavioral health, long-term and post-acute care, and community service providers." CMS also sets the conditions for broader applications of telehealth, specifically as a way to bolster network adequacy standards. "Several commenters recommended that CMS add elements (to the rule) to include triage lines or screening systems, as well as the use of telemedicine, e-visits, and/or other evolving and innovative technological solutions," officials write. "We agree with commenters that such services and technological solutions could impact the needs of enrollees in a particular area and could change the manner and extent to which other network providers are needed and utilized. We encourage states to consider how current and future technological solutions could impact their network adequacy standards." An estimated 72 million Americans currently rely on Medicaid as their source of health insurance coverage, 14 million more than in 2013, CMS said. This is largely due to the Affordable Care Act's coverage expansion. The improvements modernize the way managed care health plans operate so that Medicaid and CHIP continue to provide cost-effective, high quality care to consumers, according to Monday's announcement by Andy Slavitt, CMS acting administrator and Vikki Wachino, CMS deputy administrator and director for the Center for Medicaid and CHIP Services. The rule strengthens states' efforts to support delivery system reform and authorizes the first-ever Medicaid and CHIP quality rating system so that states can publicly report plan quality information, and people can use that information to select plans, CMS said. The rule also addresses quality of care standards, as well as focusing on improved communications, such as electronic notices to beneficiaries and creating online provider directories. "States are making gains in using population based payments, episodes of care and quality-based payments," write Slavitt and Wachino in a blog post. "In addition, states operate 30 health home programs that focus on coordinating care for people with chronic conditions like obesity, diabetes and mental health conditions. Over the last several years, sates have undertaken significant efforts through State Innovation Models, integrated care models, and delivery system reform incentive programs to create alignment with physicians and hospitals to provide the highest quality of care. And we have proven that when we and states dedicate ourselves to changing the delivery of care, we get results." Read the final rule here.

The new model is expected to work hand in hand with data and technologies to boost care, lower cost, and advance the industry toward becoming a learning health system.

The research also found that womens’ salaries grew at a higher rate than their male counterparts, while orthopedists, cardiologists, dermatologists are the highest-paid doctors.  

Rather than streamlining operations such as clinical and IT that could create significant savings, many merged organizations continue running acquired hospitals as individual entities, the consultancy found. 

The American Medical Association and 20 other groups called on the agency to refine Medicare Shared Savings to ramp up participation. 

With estimates that such programs can reduce costs by $3.27 for every dollar spent and building wellness centers can bring a 10 percent return, more and more providers and payers are getting into the wellness game.

The agency said it plans to add some 1,900 diagnosis codes and 3,651 hospital inpatient procedure codes to ICD-10.

CMS said it plans to add about 1,900 diagnosis codes and 3,651 hospital inpatient procedure codes to the coding system.