For most managed care plans, beneficiaries elect to participate in the plan. In exchange, beneficaries often have lower premiums, but often restricted access to providers (e.g., referral requirements, copayment differentials for out-of-network physicians). Medicare’s Accountable Care Organizations (known as Shared Savings Plans (SSP)) also assign beneficaries to organizations. The SSPs are groups of providers that [...]
Read the rest of this entry »Accountable Care Organizations in Medicare
I have written numerous posts about the pros and cons of Accountable Care Organizations. In 2012, Medicare begame allowing providers to form ACOs. An article by Pope and Kautter provides an overview of the initiative. The Medicare program, which covers the elderly and disabled, is the largest medical insurance system in the USA. One major [...]
Read the rest of this entry »Rationing comes to Massachusetts
Massachusetts legislature passed a first-in-the-nation bill limits the growth of health care costs in the state. “The bill would not allow spending on health care to grow any faster than the state’s economy through 2017. For five years after that, any rise in health care costs would need to be half a percentage point lower [...]
Read the rest of this entry »Accountable Care Organizations: Update on Medicare Implementation
Health Reform’s Accountable Care Act (ACA) mandates the creation of Accountable Care Organizations (ACOs). Dartmouth researcher Elliott Fisher stimulating much of the interest in ACOs by introducing the concept of an “extended hospital medical staff” at a 2006 meeting of the Medicare Payment Advisory Commission (MedPAC). Today, I review an article by Berenson and Burton (2011) describing [...]
Read the rest of this entry »What’s the difference between an ACO and Managed Care?
Medicare recently release a request for proposal for health care agencies to participate in both the Medicare Shared Savings Program and the Pioneer Accountable Care Organization (ACO) pilot project. The Pioneer ACO project is similar to the Shared Savings Program but has higher levels of cost sharing and (in year 3 of the pilot) partially [...]
Read the rest of this entry »Alternative Quality Contract
“In January 2009 Blue Cross Blue Shield of Massachusetts launched a new provider payment system called the Alternative Quality Contract that exemplifies the type of experimentation with novel payment models that the Affordable Care Act encourages. The Alternative Quality Contract is a modified global payment model in which annual payments to medical groups are linked to a per member per month budget.” Today I [...]
Read the rest of this entry »Legal Barriers to ACO implementation
Accountable Care Organizations (ACOs) are the latest rage in health policy circles. Health reform legislation will allow for federal health agencies to create waiver programs to allow for the creation of ACOs. For ACOs to actually come to fruition, the waivers must take into account existing laws which currently greatly limit the scope under which [...]
Read the rest of this entry »Three Tiers of Accountable Care Organizations
The Healthcare Economist has previously reviewed different forms of Accountable Care Organizations (ACOs). Implementing ACOs in practice, however, may prove more difficult. How could the government or private insurers incentivize providers to provide integrated care? How can they incentivize providers do perform fewer services and, thus, make less money? An article by Shortell and Casalino [...]
Read the rest of this entry »What are Accountable Care Organizations?
Accountable Care Organizations (ACOs) are the latest rage in the health policy world. The question is, what are ACOs. The Urban Institute’s Kelly Devers and Robert Berenson try to answer the following question: “Can Accountable Care Organizations Improve the Value of Health Care by Solving the Cost and Quality Quandaries?” The goal of ACOs is [...]
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