That doesn’t mean that there aren’t important concepts behind the wordage, which is why the DMCB will apologetically cross the line and use one overused expression for a classic business concept: the ‘Blue Ocean Strategy.’ While those mots remain a darling of faux-visionary business people and consultants everywhere, it’s still an important concept: there may be markets that can be made tomorrow that do not exist today.
A new market opportunity may be opening up for the disease management organizations (DMOs), thanks to the U.S. House of Representatives. The DMCB went back to the ‘America’s Affordable Health Choices Act' and looked at what it had to say about ‘accountable care organizations (ACOs). The DMCB defines these as one or more hospitals and the physicians who work within and around them who are formally organized to manage quality and cost for the local populations they serve.
Like the Medicare medical home pilot, the House bill has a similar trial program for Medicare to test the ACO. The DMCB interprets the House legi-speak to define its version of an ACO as, among other things, a physician-based a) legal structure for the receipt and distribution of incentive payments, that b) has sufficient numbers of primary care physicians, c) can collect quality measures and other data for public reporting and d) prominently uses care management planning for patients. It’s up the Secretary of HHS to set performance targets and, if they’re met, the ACO can receive payments that are, in turn, distributed to the docs. ACOs are also allowed to create similar contracts with other payers. The pilot is to start at the latest by January 1, 2012.
(There's lots more on Accountable Care Organizations here)