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New payment models and uniting care - EY - United States

New horizons: 2012 health care provider report

New payment models and uniting care

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What are the main drivers of your company’s planned acquisition activity in your chosen market/country? (respondents could select two)

Automotive capital confidence barometer - Growth

1 Source: S&P Capital IQ, 11 April 2012

Have you determined whether an ACO fits into your organization’s current strategy, business model and competing investment decisions?

Public and private payers continue to test new ways of paying for health care and delivering health care services.

From patient-centered medical homes to accountable care organizations (ACOs), federal health policy has provided for a range of pilot programs.

Considerations for your board and executive leaders

Accountable care transition

  • Has your organization considered the impacts of transitioning to an accountable care model on operations as well as on strategic and capital plans?
  • Has your board been informed about the various accountable care models being tried by federal and commercial payers and implications for your organization?
  • How will you educate and engage your staff and stakeholders in transitioning to a new model of accountable care?

Medical homes

  • Have you spoken with major health insurance providers in your area to determine their interest in establishing medical home demonstration projects? If they already have a reimbursement structure in place for medical home models, are your primary care physicians participating in them?
  • Have you considered organizing a patient-centered medical home (PCMH) model as an option for your organization’s employees, or for select subgroups of your employees? Have you worked with your commercial health insurer and primary care physician groups to facilitate such an option for the employees covered under your health insurance plan?
  • If your primary care physician practices have not yet established medical home models, have you considered compensating them for coordinating wellness or chronic care management initiatives offered to your employees — with an effort to assist them in eventual development as PCMHs? Have you considered providing education opportunities for them to learn more about the process — and to meet other providers with whom they may need to coordinate to facilitate a transition to a PCMH model?

Accountable care organizations

  • Have you determined whether an ACO fits into your organization’s current strategy, business model and competing investment decisions — and if and how potential return on ACO participation can exceed the costs of investing in an ACO start-up? If you decide to participate in an ACO-like collaborative, consider these questions:
    • Have you carefully assessed the capabilities and quality of other care providers in your marketplace to complement your organization’s capabilities?
    • Have you evaluated your capital base to determine funding requirements for participation?
    • What is your level of clinical and operational readiness for population management?
    • How are you designing payer contracting strategies to create and share value and rewards from shared savings?


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Contact us

Email Jonathan Weaver
Americas Provider Care Sector Leader

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