What ACOs mean for optometry

What ACOs mean for optometry

Optometry has yet to become fully vested in accountable care organizations (ACOs). But it's a care model that's growing in number and changing the health care landscape.

"Make phone calls. Be persistent. Each of the state associations should know whom the ACO players are in their state."

ACOs are a response to a growing emphasis on population health management and the need for value-based care models. These advocacy models will replace traditional, less integrated fee-for-service care models, Lendy Pridgen, director of the AOA's Third Party Center (TPC), observed during a recent AOA webinar on Affordable Care Act developments.  

More than 370 ACO entities exist in the Medicare sphere, and at least 500 ACO-type entities represent thousands of value-based contractual arrangements in the private market.  

ACO-type arrangements and specific structures vary greatly. Combinations of physicians, hospitals and in some instances health plans partner to coordinate care for patients to improve efficiency and health care outcomes. In some models, these partners share savings incurred from reducing costs.  

Harvey Richman, O.D., member of the AOA TPC Executive Committee, is familiar with these models. In an excerpt from the June edition of AOA Focus, he discusses his experience with ACOs, including the Medicare Shared Savings Program (MSSP), one of the federal government's ACO programs. His practice is currently affiliated with Partners In Care ACO, Inc., a participant in the MSSP.  

What are the biggest concerns ODs have about ACOs?
Whether or not [these models] will come to fruition-and whether that's going to be the only mechanism for inclusion and provision of care.  

We need to be aware of the changing landscape as much as possible. There's an awful lot of discussion and consideration as far as doctors forming small groups to market themselves to the ACOs for provision of care. I think that education is extremely important at this point.  

Another big fear is that groups of optometrists are going to band together, and if you don't join one, it's going to prevent you from joining one of these ACOs. However, I do not believe that if a doctor doesn't get involved with one at this early stage that they will be cut out.    

Discuss your participation in the Medicare Shared Savings Program with Partners In Care.
Partners In Care is in New Jersey. They have more than 500 physicians. The majority of them are primary care physicians, and they're doing care coordination with us, making sure the quality outcomes are what they're supposed to be. We have a nurse who communicates with us to make sure the medical home model is being followed.  

I got involved in this because there are several primary physicians in the area whom I'd been providing care with anyway. They had discussed this as a change in the provision of services in my region, and I made some phone calls and got involved. It was a lot of communication with a lot of different people.    

What's your advice for ODs interested in joining an ACO?
Make phone calls. Be persistent. Each of the state associations should know whom the ACO players are in their state. ODs should be making phone calls to the credentialing people. They should be discussing this with the primary care doctors in their area to find out whom they are participating with.  

Once you get to speak to someone, make sure that you use three key phrases: electronic health records, quality measures (meaningful use and the Physician Quality Reporting System), and board certification. The ACO management is looking to keep costs down with increased quality, and these are signs that you are willing to do so.  

To get involved with an ACO, use the AOA's Optometrists' Guide for ACO Participation and ACO Resource Toolkit at aoa.org/acotoolkit (member login required).  

June 25, 2014

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