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US ACO IT Spending Outlook 2020

  • March 2016
  • -
  • RNCOS
  • -
  • 85 pages

Cost pressures associated with ageing populations and an increase in the numbers of people with chronic illness in the United States creates a need for more accountable and integrated forms of delivering health services. With the growing assurance of quality care at reduced prices, the number of ACO enrollees is growing tremendously in the US. The United States spends more on healthcare than the next-highest 10 countries combined. With the growing popularity of ACO programs, it is expected that number of lives covered by ACO would grow at a CAGR of around 20% during 2016-2020, and the number is projected to reach around 76 Million by the end of 2020.

In their latest research study “US ACO IT Spending Outlook 2020”, RNCOS’ analysts have identified and interpreted the market’s dynamics in important segments to clearly highlight the areas offering promising possibilities for companies to boost their growth. The report gives a detailed outlook of the US ACO market, providing a complete study of the current ACO scenario in the country. The report provides complete information about the major ACO population, principles and benefits of ACOs, eligibility and time constraints for creation of ACOs, and the critical success factors as well as key challenges faced by emerging & existing ACOs.

The report covers a detailed analysis of the types of ACOs operating in the country. ACOs, although having the same principles and objectives, can be broken down into different categories based on the number and leadership structure of parties involved in the ACO, the services provided directly by the ACO, and the services provided through contracted entities. The types of ACOs have been segmented into three major categories viz. Medicare ACOs, Medicaid ACOs and Commercial ACOs.

Further in this report, the current estimation of the US ACO IT spending has been provided, with forecast till 2020, to provide a comprehensive knowledge about ACOs’ spending on hardware, software and services. In addition, a detailed cost analysis of IT infrastructure, including start-up and operating cost, is also incorporated in the report.

Besides this, the report also covers the statistics of patients managed by existing ACOs in the US, both country and state wise, coupled with the future prospects till 2020. Also, the report studies various payment options of ACO viz. Shared Savings Method, Partial Capitation, Bundled Payment and Global Payment, which would help clients make wise decisions while entering the ACO market.

The report further delves into the present regulatory environment related to the industry, and contains a gist of the rules & regulations laid down by CMS that need to be followed by the ACOs under the Affordable Care Act. Further, it highlights the key challenges faced by ACOs, giving insights about the entry level challenges and legal hurdles that are hindering the growth of ACOs in the country and the problems that arise in bringing together payors and providers.

Furthermore, to provide a balanced outlook of the US ACO market to clients, our report includes the profiles of major ACOs operating in the US, with their business overview and recent developments. In nutshell, the research provides all the pre-requisite information for intending clients looking out to venture into this market, and facilitates them to devise strategies, while going for an investment/partnership in the US ACO market.

Table Of Contents

US ACO IT Spending Outlook 2020
1. Analyst View
2. Research Methodology
3. Healthcare Market Snapshot
3.1 Healthcare Spending
3.2 Medicare Spending
4. Accountable Care Organization (ACO) - An Overview
4.1 Introduction
4.2 Types of ACOs
4.3 Types of ACO Contracts
4.3.1 Medicare ACOs
4.3.1.1 Medicare Shared Savings Program
4.3.1.2 ACO Investment Model
4.3.1.3 Advance Payment ACO Model
4.3.1.4 Comprehensive ESRD Care Model
4.3.1.5 Pioneer ACO Model
4.3.1.6 Next Generation ACO Model
4.3.2 Medicaid ACOs
4.3.3 Commercial ACOs
5. Lives Covered under ACOs
6. ACO IT Spending Outlook to 2020
6.1 Hardware
6.2 Software
6.3 Services
7. ACO Creation
7.1 Eligibility for an ACO
7.2 Steps and Time Required
7.3 Cost Required for IT Infrastructure
7.4 Critical Success Factors
8. ACO Payment Models
8.1 Shared Savings Method
8.2 Partial Capitation
8.3 Bundled Payment
8.4 Global Payments
9. Regulatory Environment
10. Key Challenges
10.1 Challenges at Entry Level
10.2 Legal Hurdles
10.3 Coordination between Payors and Providers
10.4 Data Integration
11. Future of ACOs
12. Profiles of Major ACOs
12.1 Advocate Physician Partners
12.2 Partners HealthCare
12.3 Allina Health
12.4 UnityPoint Health
12.5 Banner Health Network
12.6 OSF HealthCare System
12.7 UW Health ACO
12.8 Heritage California ACO
12.9 Physician Organization of Michigan ACO
12.10 Atlantic ACO

List of Figures:

Figure 3-1: Healthcare Expenditure (Trillion US$), 2013-2020
Figure 3-2: Medicare Expenditure (Billion US$), 2013-2020
Figure 4-1: Number of ACOs (2011-2014)
Figure 4-2: Breakup of Medicare and Non-Medicare ACOs (%), 2013
Figure 4-3: Number of ACOs by States, January 2015
Figure 4-4: ACO by Sponsoring Entity (%), 2015
Figure 4-5: Number of ACO by Type of Contracts (2011-2014)
Figure 4-6: Number of MSSP ACOs by County
Figure 5-1: Number of Lives Covered by ACO (Million), 2013-2020
Figure 5-2: Population Covered by ACOs, by State (%), January 2015
Figure 6-1: IT Spending in ACOs (Million US$), 2013-2020
Figure 6-2: Spending on Hardware (Million US$), 2013-2020
Figure 6-3: Spending on Software (Million US$), 2013-2020
Figure 6-4: Spending on IT Services (Million US$), 2013-2020

List of Table:

Table 4-1: Types of ACOs
Table 4-2: Organizations Participating in Pioneer ACO Model
Table 4-3: Organizations Participating in Next Generation ACO Model
Table 7-1: Timeline for Setting-up ACO Services
Table 7-2: Estimated ACO Start-up Cost

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