Tuesday, April 8, 2014

Doubling Down on Accountable Care Organizations

What happens if CMS' grand experiment in ACOs fails?

There are some good reasons to believe that it could happen:

  • Preliminary results are spotty at best

  • Saving money doesn't mean making a profit

  • inefficiencies, technology shortfalls, culture barriers and inertia abound;

  • bending the curve for sick populations is hard;

  • physician and patient behavior change is difficult;

  • last but not least, it was tried before

  • But note that the Population Health Blog is not asking whether ACOs are going to fail.  That jury is still out.  The question is IF they fail, what happens next?

    While the Population Health Blog Spouse would common-sensically expect the contracts to be cancelled while our national leaders look for the next good idea, the PHB doesn't expect that to happen.  For an example of the thinking behind a far more likely scenario, check out this article by RWJF Advisor and former Health Affairs Editor Susan Dentzer.

    Despite some early bad news, Ms. Dentzer exclaims that she's not about to let any inconvenient facts get in the way of further "improvement" of the ACO model. 

    Among her ideas for doubling down and expanding it:

    1. Tying discounts on Part B premiums "or other financial incentives" to get Medicare beneficiaries to agree to a more narrow network.

    And why, asks the PHB is this any different than managed care?  Or maybe ACOs are destined to be HMOs in "drag!"

    2. Tying discounts or other financial incentives to the use, whenever possible, of the lowest level of care.

    This is another long-used managed care tool that can justify keeping patients out of the hospital.  And the PHB would vote for RuPaul as the ACO National Medical Director. 

    3. Expand the use of multi-disciplinary team-based care for persons with chronic illness.

    A good idea, but teaming of medical home can succeed quite nicely outside of ACOs.

    Hey, says the PHB, if CMS can pull the rug out from under Medicare Health Support, it should be able to do it to ACOs.  Fair is fair.

    Image from Wikipedia

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