By Avery Johnson
The Wall Street Journal
March 28, 2011
The 2010 health-care law encourages the development of accountable-care organizations as a way to improve care and reduce costs.
So what exactly are accountable-care organizations, anyway?
In broad outline, these entities propose to unite doctors and clinics or hospitals in groups that pool their resources with the goal of trimming spending while boosting the quality of care. When the group can show that it is improving care and delivers it for less than the cost projected—arrived at by crunching historical patient data for that market—a share of the savings goes to the ACO’s bottom line.
ACOs exist more on paper than in reality, for now.
“An ACO is like a unicorn; everyone thinks they know what one is, but no one has ever seen one,” says Gene Lindsey, president and chief executive of Atrius Health.
Elliott Fisher, the Dartmouth Medical School professor who helped coin the term ACO, and who worked with members of Congress to draft the ACO concept into the health-care law, concedes that “there are some really important questions about whether this will work.”
But, Dr. Fisher adds: “I think it’s the best hope we have.”
http://online.wsj.com/article/SB10001424052748703300904576178213570447994.html
And…
Cost control the next step for Massachusetts health reform
By Tanya Albert Henry
American Medical News
March 28, 2011
In February, Massachusetts Gov. Deval Patrick unveiled his cost-containment plan to follow up on the landmark 2006 coverage expansions. If approved by legislators, it would define and encourage accountable care organizations within the state; give the state insurance commissioner the ability to scrutinize insurers’ rates, including underlying physician pay, and disapprove rates that are excessive; and revamp the medical liability system to try to resolve disputes more quickly and curb defensive medicine.
Accountable care organizations
* Mandates that ACOs provide patient-centered primary care coordination and referral services.
* Requires ACOs to share financial risk, distribute savings and meet quality measures.
* Expects ACOs to be competent in population health management, financial and contract management, quality measurements, and communication.
* Charges ACOs with providing behavioral health services, either internally or by contract.
* Makes physician participation voluntary.
* Allows primary care physicians to belong to only one ACO but places no limits on specialists.
* Requires MassHealth, the Group Insurance Commission, the Commonwealth Connector and all other state-funded insurance programs to implement ACOs and alternative payments by January 2014.
http://www.ama-assn.org/amednews/2011/03/28/gvsb0328.htm
Comment:
By Don McCanne, MD
Accountable care organizations (ACOs) began as an abstract concept of integrating health care providers into a not-yet-defined entity that would be rewarded for improving quality and reducing costs. Without knowing what they were, Congress included them in the Affordable Care Act (ACA). Dartmouth’s Elliott Fisher, who was one of the first to promote the concept, now says that “there are some really important questions about whether this will work.”
Nevertheless, Massachusetts, which is serving as a prototype for the now-enacted ACA, is intending to move forward with its version of ACOs. Their model not only measures quality and distributes savings, but it also shares financial risk. Also it includes exclusive primary care networks, limiting patient choices. The intent of Dr. Fisher and his colleagues is very noble, but it appears that we may be opening up the process to enable a return to the worst of the managed care era.
Quoting from a personal communication from Steffie Woolhandler and David Himmelstein, “Universal, geographically-based, non-profit ACOs are called a national health service, a reform we would heartily endorse. Unfortunately, the ACOs actually being pursued are profit-driven recreations of full-risk capitated HMOs.”
Very soon HHS will be releasing their guidelines for ACOs. The question we need to ask then is will these organizations be designed specifically to provide patients higher quality care at more reasonable costs, as Dr. Fisher envisions, or will they be designed by businessmen to… well, you know.
