Manatt Professional Interviewed on Medicaid as Model for ACO
"Can Medicaid be a Model for ACO Innovation?"
HealthLeaders Media
July 26, 2013 - Manatt's Thomas Enders, a senior managing director with Manatt Health Solutions, spoke to HealthLeaders Media about whether Medicaid could be a model for accountable care organizations.
HealthLeaders Media reports that many hospitals and health systems have experimented with the ACO concept by working on small population groups, but they don't have the scale to bring the science and technology to the equation. Hospitals and health systems with ACO experience are most familiar with the Medicare Shared Savings and Pioneer programs. Recently, commercial payer-provider partnerships have become more common.
"There's a whole revolution going on in that space," said Enders. "Those changes [in care protocols] have to be made in advance of the payment model changing."
Because of that, systems that are conservative want to leverage a partner's capability to get into the business without putting themselves all in without a payment model that supports it, Enders said. Aetna and United are most into this, but they have their own prescriptions for how to build commercial ACOs. Most of them involve the health plan doing a lot of the medical management work.
"The philosophy behind them can be described as a tug of war," said Enders. "Providers feel like they should do the medical management," he says.