Experimenting with Payment Reform
One of the most interesting concepts which is being promoted in the national health care reform legislation are “accountable care organizations” (ACO) – new or existing health care organizations which would assume responsibility (“accountability”) for improving the health outcomes of a defined number of patients (at least 5,000) in a specific geographic area. The ACO would be required to engage a sufficient percentage of the local providers (hospitals, physicians, community health centers, etc.) so that it could establish appropriate goals for quality outcomes and then take the cost savings from that quality improvement (for example, reduced number of avoidable hospitalizations) and distribute those savings among all the providers.
What is somewhat surprising about the degree of support and interest in the concept is that this is still largely an idea based on cost analyses and savings projections from Medicare claims data, with little practical evidence that it actually works to sufficiently change the current cost and payment incentives in our health care system. Moreover, while not excluding the ability of a hospital/health system, independent practice association or health plan to be a local ACO, the model contemplates a new type of administrative organization solely focused on these issues of quality improvement and shared cost savings. Finally, there are many actuarial, measurement and legal issues to overcome to make this concept viable.
In a late and quiet announcement, the Centers for Medicare & Medicaid Services (CMS) has announced 123 new Medicare Shared Continue reading
The Centers for Medicare & Medicaid Services (CMS) has issued a request for information for comments and ideas about accountable Continue reading
The fourth annual National Accountable Care Organization (ACO) Congress was held this week in Los Angeles, California. The inaugural conference, Continue reading
This issue brief from the Integrated Healthcare Association summarizes a roundtable discussion at the 2011 Second National ACO Congress, which Continue reading
This report from The Commonwealth Fund is based on interviews with clinical and administrative leaders from seven accountable care organizations Continue reading
This 2012 assessment of the first year of work of the Center for Medicare & Medicaid Innovation (CMMI), which was Continue reading
This interesting issue brief from the American Academy of Actuaries examines accountable care organizations from an actuarial perspective. The issue Continue reading
This tool from the American Medical Group Association assesses whether an organization is ready to become an accountable care organization Continue reading
Ignatius Bau 