Questions and Topics We Can Help You To Answer:
Paper Instructions:
I need a commented response to the following classmates post. If ANY sources used please they must be easily accessible for the professor.
Original Question:
You’re a healthcare IT consultant who has been approached by a former boss and mentor who is now an angel investor and is working with a couple of venture capital firms. Your mentor would like to invest in a healthcare start-up, but has been away from the industry for several years. To bring herself back up to speed, she attended the 2018 HIMSS Conference in Las Vegas, which is the largest healthcare IT convention in the world.
She came away from the conference amazed by the number of IT solutions vendors that are focusing on data aggregation and analysis solutions built to support value-based care reporting (specifically, MIPS/MACRA requirements). While she feels that this signals a ‘hot’ market, she’s also concerned that it could indicate market saturation.
Your mentor is likely to offer you the opportunity to lead the creation of the start-up, but she’s reluctant to move forward with next steps without evaluating two, high-level options: (1) a product-focused start-up that will develop a solution that will streamline MIPS reporting for ACOs, or (2) a services-focused start-up that will provide consulting services to ACOs that are focused on ‘checking the boxes’ for ACO compliance and reporting, but that need help optimizing and sustaining their internal operations and care delivery functions.
On the basis of what you know right now, which option would you recommend?
****Classmates Response to Original Post****(RESPOND TO THIS POST):
I would recommend a service oriented startup to assist in ensuring compliance with ACO agreements. I feel that the primary goal of an ACO is to streamline the costs associated with particular conditions, and to focus more on preventing the need for additional care rather than getting paid for services provided, as part of the Triple Aim. This is because this is an agreement between a healthcare payor (insurer) with the providers. With an ACO, typically healthcare organizations are only given a set amount per patient, which varies depending on the conditions that the patient has, although there are several reimbursement models that CMS uses (Centers for Medicare & Medicaid Studies, 2020). Medicare and Medicaid aren’t the only payers that enter into ACO agreements, some large payors are also trending to them as well, such as Blue Cross Blue Shield of Texas (Shinneman, 2018). This could be due to the disruptive innovation brought forth by the ACA creating insurance exchanges, creating a greater need for insurance companies to compete to offer better benefits at a lower cost (Wanamaker, 2013).
The reason that I think that a startup focused on maintaining these agreements is mainly due to the market size of the health IT consulting industry, how new ACO agreements are to the sector, and the growing incentive to push these types of agreements instead of fee for service models. There are already companies that have solutions for the compilation of health data that would need to be reported as part of ACO agreements, and the EHR vendors would probably have an incentive to make this data available if they wanted to retain existing customers and acquire new customers, or perhaps create tools to allow customers to compile the data requested by the ACO agreements themselves. The sale of services is probably a bit easier than the sale of the software as well, since you would be better able to directly correlate the services that are offered with the increased return that they would bring.
References:
Centers for Medicare & Medicaid Studies. (2020, January 30). Accountable Care Organizations (ACOs): General Information. Retrieved February 6, 2020, from https://innovation.cms.gov/initiatives/ACO/
Shinneman, S. (2018, July 25). Baylor Scott & White's ACO Signs A Deal With BCBSTX. Retrieved February 6, 2020, from https://www.dmagazine.com/healthcare-business/2018/07/baylor-scott-whites-aco-signs-a-deal-with-bcbstx/
Wanamaker, B. (2013, September 30). Disruptive Innovation and the Affordable Care Act. Retrieved February 6, 2020, from https://thehealthcareblog.com/blog/2013/09/26/disruptive-innovation-and-the-affordable-care-act/
