Wednesday, December 28, 2011

Of Accountable Care Organizations, Pioneers and Potatoes

It wasn't long after the Dec. 19 CMS announcement that the Pioneer Accountable Care Organization Program had launched that the champagne health policy corks began to pop.  According to writers in the Health Affairs blog, ACOs have the "potential" to align incentives, leverage electronic health records, harmonize government and commercial insurers and improve care.  After that they'll potentially restore the polar ice caps, save the Euro and help Facebook finally realize that its users are the customers, not the product.

But in all seriousness, recall that Pioneer will run parallel to the bigger "Shared Savings Program." The purpose of Pioneer is to test the ability of already integrated health systems to function as ACOs.  From a pool of anonymous applicants, CMS' "Innovation" center chose 32 "winners."

You can read how their contracting arrangements will work here.  As the Disease Management Care Blog understands it, it'll involve an optional Chinese menu of threshold-dependent and first-dollar shared savings and/or full capitation.

It all reminds the Disease Management Care Blog of potatoes.

Why would the DMCB chose the lowly spud to make its point about ACOs, you ask?   Read on:

Align incentives?  Under shared savings, health care providers will ultimately bill less and receive a fraction of any savings in return.  If you like that business model, the DMCB would like to pay you a dollar less for any bag of potatoes you've just bought and give you 50 cents to reward you for our "shared savings."

Electronic records?  If the ultimate leveraging of the EHR is to improve care coordination, the bad news is that there is still a large gap between the hard science of EHRs (here and here) and wishful jargon.  In other words, documenting they're potatoes and what you've done to them in some computer still doesn't make 'em any easier to cook.

Commercial payors?  Unencumbered by miles of regulations, statutes and political meddling, commercial ACOs are already miles ahead of CMS.  At a recent holiday meal, the DMCB spouse served traditional boiled spuds.  She also served up a creative casserole of shredded potatoes mixed with sour cream and cheese.  One was much more tasty.  One was not.  'Nuff said.

Improve care? Ten years ago, James Robinson said it best: our problems are limited resources, unlimited expectations, widespread skepticism and reduced tolerance for interference with individual  autonomy.  We have 20 lbs of potatoes.  The ACO bag is made for ten lbs.  Good luck.

Image from Wikipedia

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