BURLINGTON, Mass.--()--Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, finds that nearly one-fifth of surveyed clinicians currently participate in an accountable care organization (ACO) and—within the next 12 months—49 percent of all surveyed primary care physicians and 53 percent of surveyed endocrinologists expect to do so, as provider groups and managed care organizations (MCOs) increasingly adopt ACOs. Furthermore, physicians and MCOs point to all indications or all excluding transplants as being included in ACO contracts being signed over the next year.
“The emergence of ACOs is now upon us and these entities will present challenges and opportunities for the drug industry. A focus on costs and generic prescribing targets could harm branded therapies, but a push for drug compliance and screenings may increase the number of patients taking specific medications.”
The new U.S. Physician & Payer Forum report entitled Accountable Care Organizations: How Will Payer and Provider Adoption of This Model Impact Prescribing Trends in Cardiometabolic Diseases? also finds that physicians currently participating in ACOs contract with a number of payer-types, highlighting how rapidly this program is expanding across the industry. The majority of surveyed physicians who currently participate in an ACO report that they contract with commercial plans and 59 percent also have agreements with Medicare Advantage and Medicaid MCOs.
"The expected growth of ACOs is quite staggering as both MCOs and physicians appear to be buying into the core concepts of ACOs and, in many ways, we're just now seeing the tip of the iceberg for ACOs,” said Decision Resources Product Manager Roy Moore. “The emergence of ACOs is now upon us and these entities will present challenges and opportunities for the drug industry. A focus on costs and generic prescribing targets could harm branded therapies, but a push for drug compliance and screenings may increase the number of patients taking specific medications."
For physicians contracting with commercial ACOs, compensation is tied to metrics intended to reduce costs and shift prescribing towards specific therapies. A majority of both endocrinologists and PCPs say their compensation is tied to generic dispensing rates although a higher percentage point to clinical outcomes such as hospital readmissions. As a result, prescribing of favored therapies like Merck’s Januvia (for type 2 diabetes) and generic statins have increased.
The report also finds that, among surveyed MCO pharmacy directors, 15 percent currently contract with an ACO, and a further 52 percent expect to do so in the next year. MCOs currently contracting with ACOs have largely focused their efforts on hospitals and integrated delivery networks, but future efforts will target smaller physician groups and even solo practitioners. Surveyed pharmacy directors believe ACOs can improve outcomes among patients with type 2 diabetes. This finding results from the proven clinical benefit of care management in treating the millions of beneficiaries suffering from diabetes. The ability of preventive medicine to stymie costly medical use likely drove 62 MCO pharmacy directors and medical directors to identify type 2 diabetes as the condition that could see the most reduced costs because of an ACO.
Fifty-four percent of surveyed pharmacy directors cited congestive heart failure (CHF) as one of two indications most likely to see improved outcomes from ACOs. In addition, 44 percent of surveyed pharmacy directors identified CHF as among the top 2 for cost savings, likely reflecting the availability of low-cost generics.
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