If ACOs Aren’t Saving Money, What is the Future of Value-Based Care?

At the recent AHIP meeting in Chicago, health insurance executives lamented the unexpected ineffectiveness of private payor ACOs in lowering costs and improving quality. Why? “Providers and insurers need to do a better job of reaching patients and employers, according to physician executives at four large health insurance companies.”

It’s not often that we see the success or failure of care coordination and clinical initiatives laid at the doorstep of marketing communication. Yet that’s exactly what these executives said.

This article in Modern Healthcare went on to say, “Most of the time, patients are not even aware they are part of an ACO … HCSC runs Blue Cross and Blue Shield of Illinois, which has made numerous ACO pacts, including one with Advocate Health Care, a sprawling system based in Downers Grove, Ill., and one of the largest commercial ACOs in the country. But the insurer’s HMO plans have done just as well if not better with cost control and quality improvement, because consumers are much more engaged, and because the HMO’s benefit design is clear.”

So success is tied to consumer engagement and clear communication around benefit plan design. The article also points out that physician engagement is clearly a driver of success, since many physicians may participate in an ACO but they are still compensated and incentivized for typical FFS performance and may not even understand the incentives around their ACO patients. So incentives matter, but so does physician engagement, and that is a direct result of effective and strategic communication designed to engage them.

These remarks on ACOs seem significant. First, they call into question the effectiveness of ACOs, which are clearly a cornerstone strategy for many provider organizations pursuing value-based care. Second, they clearly identify the need for provider and consumer engagement strategies, and that requires a deep understanding of the B2B side of healthcare.

Part II: What are Blues Doing to Drive Employer Engagement in Value-Based Care?

November 18, 2015
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