Now that broad-based accountable care organizations are taking off in the private sector and Medicare, a handful of organizations are launching ACOs focused solely on pediatrics.
That there aren’t more pediatric ACOs is surprising, given the health reform law mandate that HHS establish a pediatric ACO demonstration project to start Jan. 1, 2012. Under Sec. 2706, HHS was to set up a four-year pediatric ACO demo “in the same manner” as the Medicare Shared Savings Program. But little progress reportedly has been made on that program. A handful of states — Colorado, New Jersey, Oklahoma, Oregon and Utah — are in the beginning stages of forming Medicaid ACO pilots, with Colorado the furthest along.
The private sector again has taken the lead in forming accountable care entities specializing in care for children. Among some notable examples: Partners for Kids, run by Columbus, Ohio-based Nationwide Children’s Hospital; San Diego-based Rady Children’s Hospital, which is working to develop a pediatric ACO that will operate in Medi-Cal; and Kansas City, Mo.-based Children’s Mercy Hospitals and Clinics, which is focusing on building an integrated pediatric network.
Some industry insiders say a sharper focus and a better-defined patient population may actually make pediatric ACO development easier. “Pediatrics…is not condition-specific, but is rather a unique patient set,” says Erik Johnson, a consultant at Washington, D.C., consulting firm Avalere Health LLC. “Still, I don’t think it’s efficient for a health system that’s based on a children’s hospital to set up a pediatric ACO with the expectation that one group of patients will be treated differently than another because of age, condition or payer.”
And consent issues may throw a wrench in pediatric ACOs. “It shouldn’t be hard to get parental consent, but it might be. And the issues around privacy and consent in the pediatric realm are huge,” Johnson says. For example, “the rapid-fire information exchange that ACOs require could be severely inhibited if you have to solicit parental consent in each instance. It’s a unique factor that makes it difficult to envision how a pediatric ACO is going to operate smoothly.”
What do you think -- will pediatric ACOs take off in the current environment of rising entitlement costs and state budget woes?