How will ACOs help primary care physicians not rely on emergency rooms and specialists to off-load the work of complex patients? Foch grapes do not a Chardonnay make.
In reading the report, the paranoid DMCB gets the distinct impression that the "shared savings" are really intended to build a better - and bigger - health care delivery system. Yet, if the PCMH does its job, the ACOs will need smaller hospitals and fewer specialists. If money doesn't get taken out of the system, how will the ACO business model succeed?
Water: This is a patient population of 'sufficient size' from multiple payers, including Medicare, to support performance measurement and stability of expenditure projections. The authors suggest an ACO needs 70% of patients in a shared savings pool to make this work.
The DMCB can't tell how the planners intend to format and reconcile claims data from multiple payers and then mix it in with clinical data from pharmacy and clinical electronic records. More to follow.......
This is a good point, but the DMCB cautions that being a physician leader or CEO may not automatically qualify anyone for running a risk-bearing ACO. For that, an ACO may need an insurance executive or someone from the disease management industry.
The same can be said of ACOs.