Accountable Care Organization Congress: Plenary Session with Shortell and Casalino

Today’s morning plenary session at the National Accountable Care Organization Congress, featured two of the national thought leaders on accountable care organizations (ACOs): Dean Stephen Shortell from the University of California, Berkeley School of Public Health and Professor Lawrence Casalino from Weill Cornell Medical College.  Dean Shortell asked whether ACOs would be the payment reform to finally tip the U.S. health care system away from a fee-for-service payment system and discussed three components of ACOs which he called necessary but insufficient by themselves to drive payment reform and quality improvement: organizational capabilities (primarily electronic health records and practice redesign), performance measurements (for accountability) and payment incentives (for results or quality outcomes).  Professor Casalino elaborated on what capabilities and incentives will be needed for successful ACOs.  In terms of capabilities, he emphasized the importance of leadership and of participating providers’ organizational cultures.  Casalino also noted that most of the early cost savings would most likely come from reduced (avoidable and unnecessary) hospital admissions and fewer (unnecessary) office visits to specialty physicians, raising the stakes for hospitals and specialists about how any “shared savings” might be distributed.  Finally, he wondered whether ACOs would help reorganize many solo and small group physician practices or drive them further into financial instability.

Here are three of the key articles Shortell and Casalino have co-authored about accountable care organizations:

Shortell SM, Casalino LP. “Health care reform requires accountable care systems.” JAMA (2008); 300(1):95-97.

Shortell SM, Casalino LP. “Implementing qualifications criteria and technical assistance for accountable care organizations.”  JAMA (2010);303(17):1747-1748.

Shortell SM, Casalino LP, Fisher ES.  “How the Center for Medicare and Medicaid Innovation should test accountable care organizations.” Health Affairs (2010); 29(7):1293-1298.