No, I’m not talking about the Mexican dish. I’m talking about the concept of “Totally Accountable Care Organizations”, or TACOS. The TACO was the focus of a recent post on the Health Affairs blog (see Broadening the ACA Story: A Totally Accountable Care Organization) providing us with yet another acronym for ACOs that are designed for individuals with complex support needs. They wrote:
Within state-run Medicaid programs, [there are now] ACOs tailored to the care needs of Medicaid’s beneficiaries, many of whom have multiple chronic health and social challenges….[TACOs] offer the potential to push accountability for Medicaid populations, including those with complex needs, to a new level….beyond just medical care (for example, mental health, substance abuse treatment and other social supports).
Why is this important? Two reasons. First, the TACO concept puts a name to an emerging trend that our team has been covering for over a year – the need for different care management models and different consumer support models for populations with complex needs. This was captured in my presentation, Leading Through A Time Of Change: The Shifting Health & Human Service Market – & The Challenges Of Positioning Your Organization For Sustainability & Success premium members, on September 11, 2013 at the 2013 OPEN MINDS Leadership Retreat For Health & Human Service Executives.
The second reason the TACO is important, is that it’s the only market differentiator for many specialty behavioral health and social service organizations. In a market with a host of new competitors (there is a new ACO every week, newly-formed medical home organizations, and more), the ability to manage the behavioral health and social support needs (along with coordination of physical health care) of high-cost consumers is the most important competency for positioning. The demands for integrated care coordination models will provide the opportunity for specialty behavioral health and social service organizations to seize the new space in the health and human service value chain or accept the role (which is not a bad role by the way) as a boutique specialty service provider (see The Evolving Role Of Customer Expectations: New Role Created For Marketing In Behavioral Health & Social Services premium members and Integration Model Decisions Are Strategy Work At Its Most Fundamental premium members, for more on the value chain concept).
What is happening in the emerging ACO market space? ACOs are organized around a simple but power construct – health service organizations are entering into value-based reimbursement contracts. The construct was “born” as part of the Patient Protection and Affordable Care Act (PPACA) premium members but has evolved. There are now over 400 ACOs covering 12 million lives in three different payer markets – Medicare, Medicaid, and commercial. (You can review these organizations in the OPEN MINDS Accountable Care Organization Market Directory.)
The Medicaid ACOs referred to in the Health Affairs blog are under development in 19 states – Alabama, Arkansas, California, Colorado, Hawaii, Illinois, Iowa, Louisiana, Maine, Massachusetts, Minnesota, North Carolina, New Jersey, New York, Oregon, Texas, Utah, Vermont, Washington (see State ‘Accountable Care’ Activity Map). However, these initiatives are in various stages of maturity. For example, Vermont is still in the process of contracting with two ACOs — OneCare Vermont and Community Health Accountable Care LLC – to participate in a Medicaid ACO program (see ACOs Gain Wide Traction in Vermont as State Eyes Move to Single-Payer in 2017).
But, the concept is more mature in Oregon and Colorado. Oregon implemented an ACO pilot based around Coordinated Care Organizations (CCOs), and has reported a 13% decrease in emergency room visits, 32% reduced admissions for congestive heart failure, 36% reduced admissions for chronic obstructive pulmonary disease, and an 18% reduction in admissions for adult asthma (For the most recent update on Oregon’s results, see Oregon Health System Transformation Quarterly Report, February 2014: Executive Summary premium members). And as of November 2013, the Colorado Medicaid program reported $44 million in gross savings with its Accountable Care Collaborative (ACC) program (see 2014 Outlook: Medicare, Medicaid ACOs Grow as Early Outcomes Results Trickle in). And, in addition to these initiatives, the ACO concept is being adopted by Medicaid managed care plans as well.
With the “macro” shift toward integrated care management (and the success of these early models), there is a market race for which organizations will control patient care coordination (see Controlling Coordination = Controlling Referrals all members) and, by default, control health care financing and care delivery at the local and regional level. For the next few years, the executive teams of most service provider organizations will be asking one significant question in their strategic planning – “TACO, anyone?”