Aetna: Bumpy road ahead for ACOs


As accountable care organizations proliferate throughout the country, Aetna's chief of ACO operations says the organizations can continue to succeed even though they'll hit some bumpy roads ahead.

ACOs must manage operations while both the provider and insurance industries transition toward value-based payments when fee-for-service reimbursements remain dominant, Charles Kennedy, CEO of Aetna's accountable care solutions, told InformationWeek.

To go from volume to value, ACOs need to eliminate care that has no value, Kennedy said. "The question is, how do you do that in a way that allows delivery systems to be financially stable?"

Aetna's ACOs typically begin with a few years on the upside and then shift toward upside and downside risk. "We start out with a low-risk approach, then, depending on the delivery system's aggressiveness, start moving to value-based care," Kennedy told InformationWeek.

Another obstacle to ACO success is avoiding the mistakes of the 1980s and 1990s when HMOs were prevalent. Though managed care did temper rising medical costs, the approach wasn't able to completely migrate the healthcare industry to a value-based approach.

Kennedy believes the ACO approach can improve upon the HMO experience since health information technology, including electronic medical records and data analytics, have advanced. "Technology is one of the most important components of what we do,"  Kennedy said in previous interviews with FierceHealthPayer. He also called technology a "foundational requirement for ACOs," because providers need to be able to exchange, analyze and act on patients' clinical and claims information.

To learn more:
- read the InformationWeek article

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