Thomson Reuters Identifies Critical Metrics for Accountable Care Organization Success

Benchmarks for Membership, Utilization and Payment, Costs and Financial Terms Established

News provided by

Feb 21, 2012, 01:55 ET

ANN ARBOR, Mich., Feb. 21, 2012 /PRNewswire/ -- The difference between a successful Accountable Care Organization (ACO) pilot program and a well-intentioned failure could come down to just four key metrics, according to a new white paper published today by Thomson Reuters.

(Logo: http://photos.prnewswire.com/prnh/20090507/NY12658LOGO )

Thomson Reuters recently developed a model to estimate the expected financial impact of a Medicare ACO. The model uses baseline utilization and cost data for a specific organization that can be derived from public data sources and has been applied by several organizations to understand the likely opportunities and challenges of this payment model, specific to their attributed population. Modeling of a variety of baseline conditions and savings assumptions has suggested four important conditions for pilot success: 1) the number of attributed members; 2) current ACO member in-network and out-of network utilization and payments; 3) opportunities to reduce utilization and service unit costs; and 4) the ACO's baseline costs and payer financial terms.

"Those of us with long memories recall the promise of Health Maintenance Organizations in the '80s and '90s, and we recognize that a healthcare concept is ultimately only as good as its implementation," said Bob Kelley, senior vice president, healthcare analytics, Thomson Reuters. "For hospitals and other large healthcare organizations, success will depend on access to accurate information on the characteristics of population health and utilization of services. We highlight those key points in this paper to help organizations launching pilot programs start with a strong foundation in the data that matters. This foundation will help predict the financial success of the pilot."

The paper models income and cost projections for an ACO under several different scenarios such as a surge in payments to non-network providers as well as the impact of different baseline assumptions at the point of pilot launch. It also outlines specific value drivers, such as disease prevention, management of condition severity and reduced service duplications, as central components to ACO success.

A copy of the full report, Will Your Accountable Care Organization Pilot Succeed? Predict Success With Just Four Numbers can be accessed here.

About Thomson Reuters
Thomson Reuters is the world's leading source of intelligent information for businesses and professionals. We combine industry expertise with innovative technology to deliver critical information to leading decision makers in the financial, legal, tax and accounting, healthcare and science and media markets, powered by the world's most trusted news organization. With headquarters in New York and major operations in London and Eagan, Minnesota, Thomson Reuters employs 55,000 people and operates in over 100 countries. For more information, go to www.thomsonreuters.com.

SOURCE Thomson Reuters