Those with higher risk tolerance can sign up to receive a larger portion of savings achieved if they are willing to pay in the event that costs go up.
Provenzano said flexibility around assumption of risk is one reason ACOs are likely to succeed in the long-term.
“I absolutely believe that ACOs are here to stay,” Provenzano said. “The Medicare Shared Savings Model is designed to be low-to no-risk, while the Pioneer model allows higher rewards with slightly higher risks. Providers can choose the model that fits best for their own practices and patient populations.”
So far, the numbers back Provenzano up as more and more providers have applied to become ACOs. According to Secretary of Health and Human Services Kathleen Sebelius, as of July 1, 2012, Medicare Shared Savings beneficiaries total more than 2.4 million.
Newly approved ACOs will serve another 1.2 million Medicare beneficiaries in 40 states and Washington.
Concept Spreading Beyond Medicare
While the ACO concept was born as part of Medicare and health reform legislation, some of health care’s heaviest hitters—including insurers among the largest health care payers in the country—are already working to create their own ACOs in the private market.
With private insurers access to tremendous amounts of health data, they promise to become key players in the ACO marketplace in measuring quality, monitoring population health and targeting areas for cost reduction.
“As soon as the private payers got into the ACO game, it was largely over for the naysayers,” Provenzano said. “ACOs are already being created and serving patients across the country.”
In the end, Provenzano said, the long-term success of ACOs will depend on clinicians willing to commit to making them work.
“We’ve got a wooden footbridge at DaVita that represents a choice—staying on one side to wait and see what happens, or crossing over to commit to helping make something happen,” Provenzano said. “I absolutely believe that physicians who are sick and tired of the same old broken health care system are going to cross that bridge and make ACOs work.”
