Over the last several years, of all efforts to reform care delivery, health plans most prolifically adopted and implemented accountable care organizations (ACOs). As of August 2018, there were 1,011 ACOs, representing 1,477 distinct, active ACO contracts with public and private payers. These ACO contracts now cover 10 percent of the United States’ population (32.7 million lives), a 6 percent increase from last year’s estimate. Some evidence suggests that ACOs may be an opportunity for purchasers to pursue better, more affordable care for their employees – an option to bend the cost curve and address patient needs holistically. However, it’s also worth noting that some experts are skeptical of the cost effectiveness and lack of risk-sharing involved.
Given that the prevalence and reach of ACO contracts is expected to continue increasing as well as the mixed findings and opinions on the effectiveness of ACOs, it’s important that we closely evaluate health plans’ ACO offerings. Many employers are already footing the bill for employees seeking care from ACOs without any awareness of the quality of these programs and without any clear standards. For purchasers considering a narrow or tiered network approach, without a standard way to measure and compare ACO performance, it is difficult for them to justify making the leap, especially knowing that they may face additional fees and employee disruption in the short run.
CPR created its Standardized Plan ACO Reporting for Customers, or SPARC, through our inaugural collaborative to address the root of these very issues. Just as Americans have grown accustomed to seeing a nutrition label on food products, and being able to review a food’s fat, protein, and carbohydrate content, CPR intended for SPARC to clearly lay out ACO performance metrics employers and purchasers want health plans to report on. With a quick glance, employers have insight into how the ACO is performing on quality measures, how they are utilizing appropriate care services, and how much it will cost them, transparently.
CPR and its’ members are actively pushing health plans to comply with SPARC’s reporting metrics. This past Fall, three major health plans presented their book-of-business ACO performance results to CPR and its’ members using the SPARC reporting template. While it wasn’t entirely complete, this effort offered the most comprehensive and honest ACO performance reporting that CPR has seen to date and every indication from the health plans suggest that they will be able to improve their reporting on SPARC when we review it next time.
Employers, as you look ahead to 2019, we encourage you to download (for FREE!) the SPARC toolkit and demand that your health plan present on the performance of key ACOs your members access at the annual review meeting. We promise – you’ll feel more informed as a result!