Hartford Business Journal

www.HartfordBusiness.com • January 13, 2020 • Hartford Business Journal 11 high, it's a huge strain on businesses.'' Doubts persist about ACOs, limited networks The accountable care organization (ACO) model has largely been pushed by federal Medicare overseers in the wake of Obamacare, the federal healthcare reform law passed in 2008. ACO contracts involve financial rewards for providers who perform well, and, in rarer cases, financial risks (paired with potentially greater upside) for those who don't. Medicare ACOs have produced mixed outcomes over the past eight years. The model can vary in com- mercial plans, and the results are more hidden from the public, but the NexusACO plan reserves the most attractive pricing for patients willing to visit doctors and other members of the St. Francis Health- care Partners Network ACO. Ellen Andrews, executive director of nonprofit Connecticut Health Policy Project, which advocates for afford- able, quality health care for all state residents, has studied ACOs of various kinds over the past six years or so. She said she is mostly unim- pressed by the model and how it has performed in the state. "At best, the results are mixed," Andrews said. "Quality is getting better, but it's also getting better across the entire healthcare envi- ronment, so it's really hard to know if it's because of the ACOs." She reserves additional skepticism for commercial ACOs, whose outcomes and incentives are more secretive. "I actually thought this was a good idea in the be- ginning, with the proper monitoring in place," she said of ACOs. "If everybody was rowing the same way that would be great for patients." Now, she said ACOs are a key driver of healthcare consolida- tion, which leads to higher prices. "It sort of feels like this is not the way," she said. "We keep trying to shift risk around. When it was insurers that was one thing, but now they are trying to get the providers to do it as well." However, many ACOs in Connecti- cut, including UnitedHealthcare's new product, don't take downside risk, which means hospitals and physician groups don't have to shell out money if they miss benchmarks (instead they just miss out on shared savings or bonus payments). That may sound good, but at the same time, health experts have argued downside risk could help reduce health insurance costs. Farrell said the industry shouldn't give up on commer- cial ACOs, which have a generally younger, health- ier patient pool than Medicare or Medicaid, and can vary signifi- cantly from one plan to the next. "The perfor- mance of com- mercial ACOs is good with room to get better," he said. "Its perfor- mance has not been optimized, it has not reached its peak." UnitedHealthcare has published some internal study results show- ing that self-funded versions of its ACO plans have led to fewer hospi- tal admissions, readmissions and emergency-room visits, as well as shorter inpatient stays and better cancer-screening metrics. That data is a few years old. Unit- edHealthcare says it's in the process of updating it. "We can expect the fully insured NexusACO to be at least as good as the results published for the self-funded ver- sion," Farrell said. It remains to be seen how the plan will perform in the Connecticut market, where UnitedHealth- care is already a top-ranked player in the small and large group markets, as well as Medi- care advantage. UnitedHealthcare said in early 2018 that it expected to have 250,000 en- rollees in its NexusACO nationwide by the end of 2019. Asked whether it met that goal, the carrier did not provide an updated figure. Stephen Farrell, President, UnitedHealthcare of New England "At best, the results are mixed. Quality is getting better, but it's also getting better across the entire healthcare environment, so it's really hard to know if it's because of the ACOs." Ellen Andrews , Executive Director, Connecticut Health Policy Project Quality Construction + Butler Manufacturing = Repeat Customers www.borghesibuilding.com © 2011 BlueScope Buildings North America, Inc. All rights reserved. Butler Manufacturing™ is a division of BlueScope Buildings North America, Inc. 2155 East Main Street • Torrington, Connecticut 06790 Gregor Technologies, Torrington, CT | 2007 | 40,000 sq. ft. • 2009 | Addition — 28,500 sq. ft. Contact us at 860-482-7613 or visit us on the web. WE PROVIDE CT BUSINESS LEADERS WITH THE INFORMATION THEY NEED TO SUCCESSFULLY RUN THEIR BUSINESS. ARE YOU IN THE KNOW? SUBSCRIBE BY GOING TO HARTFORDBUSINESS.COM CLICK ON "SUBSCRIBE"

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