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ACOs Use Diverse Payment Models, New Report Shows

BY KRISTEN MIRANDA – With the proliferation of Accountable Care Organizations (ACOs) across the U.S., the types of financial payment models that they employ also have increased. This week, a new report by the Health Care Transformation Task Force illustrates that there is no ‘one size fits all’ financial approach for ACOs and the varied markets they serve.

The report analyzes seven types of ACO payment models, each meeting specific requirements of an ACO’s focus such as targeted patient populations, the relationship between providers and payers, and market dynamics. The report looks into various financial arrangements between payers and providers, and the level of risk, opportunities and challenges that’s unique to each model.

For Blue Shield, this report supports our view that you can’t take a cookie-cutter approach to operating ACOs. In our six successful years of operating ACOs throughout California (we now have 36), we have developed customized collaborations to help our partnerships better serve the healthcare needs of our members. For example, we use a shared annual budget, an agreed-upon set of quality metrics, and all partners in our ACOs share the risk as well as the rewards for improving care.

I represent Blue Shield of California on the Health Care Transformation Task Force, which is a consortium of patients, payers, providers, and purchasers working to transform the U.S. health care delivery system. It includes six of the nation’s top 15 health systems, four of the top 25 health insurers and leading national organizations that represent employers, patients and their families. Our goal for this report is that it will be used as a resource for organizations planning to create an ACO so they can better understand the diversity and scope of payment models available, and choose the one best suited for them and their markets.

To read the report and learn more about each of the payment models, click here.

Kristen Miranda is senior vice president of strategic partnerships and innovation at Blue Shield of California


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