Tuesday, October 22, 2013

Fwd: qotd: Are we ready for ACOs?

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-------- Original Message --------
Subject: qotd: Are we ready for ACOs?
Date: Tue, 22 Oct 2013 14:10:14 -0700
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>

Health Affairs Blog
October 22, 2013
Predicting ACO Formation: Two Studies With More In Common Than It Might Seem
By Valerie Lewis, Carrie Colla, and Elliott Fisher

At a time when policy makers, providers and payers are all trying to
make high stakes decisions about how respond to the proliferation of
Accountable Care Organizations (ACOs), divergent research findings might
feel as welcome as rain on the fourth of July.

Two recently published studies, one by our group at Dartmouth and one by
David Auerbach and coauthors in Health Affairs, both examined predictors
of ACO formation. On the surface, they appear to have some inconsistent
findings. Their core conclusions, however, are similar, and differences
in the results are readily explained. Most importantly, policy
implications are well aligned: there is much we can do to help the
transition to accountable care succeed.

A common set of policy implications.

The findings in both studies also point to challenges that deserve
further attention by policy makers. How can providers without
experience in risk-based contracts or who are in smaller, more
fragmented practices get the additional support they may need to become
an ACO? Models like the Medicare Advance Payment model are one move to
support these types of providers, but our results here and elsewhere
suggest that policymakers should be further developing programs to
support the financing of these systems, along with the development of
analytic and care coordination capabilities that are likely necessary
for ACO success.

Another important question:

How can spending and quality benchmarks be refined to encourage broader
participation? Some (including us) have suggested that paying for
improvement rather than absolute performance on quality may encourage
underperforming systems to join the ACO model. Careful thinking is
necessary from health economists and health care finance experts on how
to set cost targets that do not penalize providers already on the low
end of the cost spectrum.

The imperative of continued learning.

Perhaps the most important conclusion, however, is to acknowledge the
many uncertainties that remain. The transition to performance-based
payment systems has barely begun – and better information on what is
working and what isn't would make successful reform more likely.


Comment: If you are holding your breath to see if accountable care
organizations (ACOs) are the answer to our quality and cost issues, I
have some life-saving advice for you. Don't wait, but breathe immediately!

Elliott Fisher from the Dartmouth Institute has been credited with
coining the term, accountable care organization. Look at what he and his
colleagues have to say: The most important conclusion is that many
uncertainties remain.

One of the more important reasons for the uncertainties is that there
remains a conflict between those who support better integration of
health care (a noble goal) and those who support a business model that
smacks of MBA-driven managed care (an ignoble goal).

There are no uncertainties with the single payer model. We should
proceed immediately to the enactment of an improved Medicare for all,
and then we can afford to take years to study variations of the ACO
model to see if we can improve health care delivery.

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