SHP provides consultation and ongoing ACO management for providers interested in forming an Accountable Care Organization (ACO). As healthcare reform continues and networks begin to transition away from traditional fee-for-service models, SHP believes that providers must move from generating their revenue solely from patient care to a combination of patient care and shared savings. An ACO provides a template for providers to contract with governmental and commercial payers in a new model.
In support of ACO development, SHP provides the following services:
During our analysis, we evaluate the make-up of the group to determine of the group will be able to support ACO development. This includes things like adequate primary care representation among the providers to support the ACO beneficiaries.
For Medicare ACOs we look to ensure that the market has enough traditional Medicare beneficiaries and that the baseline healthcare costs are high enough to demonstrate savings to governmental and commercial payers.
Once it has been determined that an ACO is feasible, SHP works to develop ACO Quality Criteria. This includes:
- Promotion of evidence based medicine
- Processes to promote patient engagement
- Reporting on quality and cost measures
- Promotion of coordination of care
We also work with the group on partner selection. While providers understand the clinical side, we often find that assistance is needed on the administration side and we work to identify and vet potential ACO partners.
Ongoing Oversight and Management
Once the ACO has been developed, many ACOs continue to work with SHP to provide ongoing oversight and management. With our expertise at managed care contracting and provider enrollment, we are able to provide many benefits to ACOs. In this capacity, SHP will coordinate every step of the ACO development process from initial interest meetings to payor contracting to distribution of shared savings to its members.