Comments on: What are Accountable Care Organizations?

By: W. Douglas

W. Douglas — Mon, 30 Jan 2012 04:45:53 +0000

While ACOs aren’t perfect. The idea is a step in the right direction.
I agree that the burden from cost of malpractice, especially from
Need for defensive medicine will urgently needs to be addressed.
A mechanism also needs to be in place to fine tune the process as
we moved forward.

By: William Bithoney

William Bithoney — Mon, 04 Jul 2011 16:01:16 +0000

In our ACO the key to controlling unnecessary lab and radiology testing was developing standardized approaches to testing for many of our primary diagnoses. Close monitoring of utilization and data driven clinical discussions were also key.

By: William Bithoney

William Bithoney — Mon, 04 Jul 2011 15:59:36 +0000

In our ACO the answer for ordering fewer tests was strict management of testing based on protocols as well as reaching clinical consensus with our physicians.

By: Robert Finney

Robert Finney — Sun, 03 Apr 2011 18:02:56 +0000

Original investigations on Kaiser Permanente’s Accountable Care Organization are posted on YouTube at http://www.youtube.com/watch?v=v0h7tUymj2Y and http://www.hmohardball.com
Robert D. Finney, Ph.D.

By: prathi

prathi — Thu, 10 Feb 2011 21:47:31 +0000

ACO seems like a reasonable penacea for rising health care costs,however for providers to order less tests or procedures tocontrol costs,they would need some form of protection from malpractice suits.The very high expectation of patients that all responsibilities lie on the providers to make them 100 percent free of the disease with no personal accountability will have to change.A successful ACO will be one which needs accountability from the Insurance companies,the providers and the patients.

By: Andy

Andy — Tue, 11 Jan 2011 23:17:22 +0000

The cost containment assumptions for ACOs make sense but only if cost shifting, due to uncompensated care for the growing uninsured and under insured populations, is eliminated or significantly constrained. If it is not, ACOs will only serve insured populations. This would leave the 50+ million uninsured in a fee for service model (the ER as the primary point of care) that can only be supported by shifting their cost of care to those who have insurance and to Medicare and Medicaid. And, healthcare cost will continue to accelerate faster and faster each year overwhelming the savings that ACO in that reality may produce.

The promise of ACOs— savings, compensation based quality drivers and competition—depends very much on a level playing field in which everyone (just about) is insured.

Another element of the ACO discussion seems to anticipate that insurance or Medicaid/Medicare payments would cover 100% of the cost of care. But we know that patients will have significant out of pocket payment responsibility…20% for Medicare. Is current thinking that a patient will receive one bill from the ACO for balances after insurance and deductible, owed to all providers of services who participate with the ACO?

By: » Grand Rounds 1.11.11 | It’s Complicated FDAzilla Blog

» Grand Rounds 1.11.11 | It’s Complicated FDAzilla Blog — Tue, 11 Jan 2011 08:06:32 +0000

[...] the rage recently in the health care policy arena has been about Accountable Care Organizations (a refresher on what they are). Here’s a take from someone who’s kicked the tires a bit. One blogger is skeptical [...]

By: Tracy

Tracy — Sun, 28 Nov 2010 06:46:56 +0000

You can’t apply a two dimensional business model to a three dimensional health care system. In a business model there are buyers and sellers. In a health care model there are buyers, sellers, and payers. The third dimension, health insurers, is what makes the health care industry a whole other breed of animal.

When doctors compete on prices (first) they don’t say “hey that doctor is charging $100 less than me so I better lower my price!” Rather, the other doctor says, “that doctor is charging $100 more than me I better raise my price!”

While I agree that ACOs may just be the reimbursement flavor of the week, to argue that prices should be set by the market is naive. There have been severe market failures in the health care industry which is why prices are spiraling out of control and the federal government is trying to find new payment mechanisms.

By: Todd

Todd — Tue, 16 Nov 2010 16:35:01 +0000

ACO’s do not address the two biggest fundamental problems with the health care marketplace:
1) Providers should be competing on price first then quality; this simply must change or cost will continue to spiral upwards.
2) Federal and state governments are too involved in providing services and coverage to a significant share of the market.

Even if the ACO model can deal with some sort of capitation, the market should set the price thresholds, not some analyst based on some model.

By: tom Shelby

tom Shelby — Tue, 11 May 2010 13:56:02 +0000

ACO’s are another imaginative attempt to change the landscape without changing the landscape. That is, they do not address fundamental flaws in business models that also characterize existing financing mechanisms. For example, to be efficacious, they would require a very broad base of clientele or else successful managment of the risks is not viable. And they would require very long term contracts with providers that include penalties for early termination. Unless they can construct truly better business models, they are an exercise in futility.