ACOs: Industry's Role in Bringing Providers and Payers Together

Proceedings from the 12th Biennial Meeting of the International Andreas Gruentzig Society:  Brazil – 2014
From SESSION 11 – Industry Roundtable
Moderator: Jeff Marshall, MD
Panelists: Sam Conaway, Matt Franklin, Lillian Garcia Palmer, Melissa Gindling, Paul Goodman, David Kallend, Richard Shaw, Jason Struck, Mike Vonesh

Framing the question at hand, what is the state of the current knowledge?
Accountable care organizations (ACOs) are anticipated to become a potent force in the delivery of healthcare in the near future. In the United States, ACOs are one of the central planks in the Affordable Care Act. The penetration of ACOs in the marketplace has been relatively slow to develop for a number of economic and governmental control issues.  The initiation of an ACO is a complex, governmental, and highly regulated endeavor.  While there had been some forays of industry into payment and reimbursement areas that are similar to, but on a smaller scale to ACOs (e.g. pharmaceutical companies meeting with payers and drug development) most are unsure how industry can participate in this ever-changing and uber-regulated environment.  

What are the gaps in the current knowledge?
One of the tenets of ACOs is payment based on quality that the government has notoriously been poor at defining.  For example, the 30 day readmission rate following percutaneous coronary intervention was proposed as a quality measure for interventionalists.  Data from recent papers has clearly shown that 30 day readmission rates are not related to the quality of the intervention but instead to the underlying complexity of advanced vascular disease prior to intervention.  The variability in utilization of certain interventional procedures does not give a clear signal of improved outcomes (higher rates of interventional procedures do not result in a reduction of the most important outcomes). Could ACOs reduce this variability in utilization?  The uncertainty regarding new models of reimbursement makes the gamble on new device development even more risky. Understanding the means by which costs will be streamlined will impact the business model of the device development.

Our Summary and Recommendations:
The uncertainty of wholesale changes in reimbursement, dictated by the ACOs, provides opportunities to create partnerships with interventionalists in multiple medical disciplines, industry, payers, patient advocacy groups and governmental agencies. This group of stakeholders needs to have a seat at the table so that the desired cost savings created by the ACOs does not strip all profits from industry thereby crippling research and development for new devices.  The opportunity to reduce costs is exciting, but the execution of a plan or plans to accomplish this must have all stakeholders at the table.