accountable care organizations


Cartoon Solves Health Care Puzzler: What The Heck Is An ACO?

Ladies and gentlemen! Announcing a whole new film genre: Wonk Cinema!! And what we hope will be the first in a series of CommonHealth cartoons dedicated to helping people stay awake as they learn about important health care changes that affect their lives.

Our first topic: “What the heck is an Accountable Care Organization?” Five minutes, just five minutes, to unravel one of the great mysteries of the universe! Explain the inexplicable! Destultify the stultifying! Also, to cast much-needed light on a health care phenomenon that is sweeping the state and the country…

We’re taking requests for other topics so soporific and esoteric they can only be explained tolerably in a cartoon video. What should we do next? Tiered health insurance? Payment reform? Please lodge your suggestion in the Comments section below.

And deepest thanks to former Boston Globe health care reporter Jeffrey Krasner, now president of Krasner Health Strategies, for lending his deep knowledge and rapier wit to this project. Continue reading

Potential Minefields On The Path Toward ACO’s

Bruce Landon, a primary care doctor at Beth Israel Deaconess Medical Center, considers the future of ACO's

Bruce Landon, an internal medicine doctor at Beth Israel Deaconess Medical Center, offers a smart analysis of ACO’s (accountable care organizations) — their potential for both good and bad — in this week’s New England Journal of Medicine. The key, says Landon, who is also a professor of health care policy at Harvard Medical School, is how, exactly, organizations choose to divide their global budgets, and whether they plow money back into primary care to shore up the foundations of a prevention-focused system, or whether monies continue to flow, as they have, toward a fee-for-service, specialist-driven arrangement.

Landon writes:

Conceptually, global payment represents an important opportunity for changing the perverse incentives inherent in our current fee-for-service system. To be successful, however, ACOs must pass these incentives along to their member physicians, who continue to be responsible for most utilization decisions. Although organizations can implement various managerial strategies to influence physicians’ decision making (e.g., radiology decision support and prior authorization), ACOs are unlikely to reduce the rate of increase in health care spending without some essential changes in the behavior of member physicians — and therein lies the rub. [My bold]

The fundamental questions become how ACOs will choose to divide their global budgets and how their physicians and other service providers will be reimbursed. Thus, this system for determining who has earned what portion of payments — keeping score — is likely to be crucially important to the success of these new models of care. Continue reading

New Rule Makes It Easier For Docs and Hospitals To Join ACOs

Berwick: New rule should 'create a more feasible on-ramp' for providers

Kaiser Health News reports on the long-awaited “final rule” governing Medicare accountable care organizations, or ACOs, the much-touted managed health care systems that under national health reform are supposed to better coordinate care while saving money.

The regulations, released today, cut the number of performance measurements required from hospitals and physician groups, eliminates electronic health record requirements, removes financial risk for some providers and makes up-front money available for rural and small physician-owned groups.

Introducing the new regulations in a commentary in today’s New England Journal of Medicine, Donald Berwick, the administrator for the Centers for Medicare and Medicaid Services wrote that the easing of these and other restrictions should “create a more feasible and attractive on-ramp for a diverse set of providers and organizations to participate as ACOs.”

KHN reports:

The administration made several concessions to the health industry in the final rule announced Thursday. Continue reading