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Can Mass ACOs & ICOs Co-Exist? Wait…What is an ICO?

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For those keeping track at home, ACO is the acronym for an accountable care organizations. Under the new growth capping law Chapter 224 passed in July of 2012 here in Massachusetts, they are given strong contractual preference to deliver care for all state programs, and for those in the non and small group markets.

They also were part of the ACA at the federal level. In fact, five provider systems in Massachusetts have been federally registered as an ACO.

In the new Massachusetts Medicaid “duals” pilot program, for 110,000 individuals on both Medicare and Medicaid, the state recently selected six insurer-centric ICO ” integrated care organizations” to deliver the care.

So one is prone to ask:

Will these two parallel systems of integration co-exist easily or will there be confusion?

Why did no ACO apply for ICO status OR if they did, why were they not selected?

Will placing 110,000 dual-eligibles into insurer-centric ICOs make it harder for the state to reach its goal of having most of the Medicaid population in ACOs in the near future?

Finally, Chapter 224 mandated the creation of “smart-tiering” insurance products, which tier/group by individual medical service instead of by provider or even provider group. Put another way, smart-tier products operate on the exact opposite principle of an ACO. So how will ACOs and ICOs co-exist with “smart-tiering” insurance products?

Find me on twitter: @josharchambault

UPDATE: I was reminded that Partners recently acquired Neighborhood Health Plan, one of the newly selected ICOs. So indirectly you have an ACO involved in the duals program. It will be interesting to learn more about how Partners will play in this duals project given it market position and their flagship institution being centrally located in downtown.