Friday, May 14, 2010

Acountable Care Organizations: Links and Peer Review Literature

The Disease Management Care Blog has several posts devoted to the topic of Accountable Care Organizations (ACOs). Not only has there been significant web traffic aimed at the topic, but there isn't a hospital administrator, academic chairman, VP of medical affairs, consultant, medical director, policymaker, practice manager, regulator, consultant, venture capitalist, medical blogger, masters degree student or health news writer that doesn't realize that ACOs are the Obama Administration's best hope for putting Integrated Delivery Systems into mainstream health care.

Is it more-of-the-same and inside-the-beltway-hype or Obamaesque hope? Here are the all the links you need to help you decide:

Accountable Care Organizations: Here's a Manuscript That Helps Us Move From the PPACA Legislation to Actually Making It Happen reviews and links a Journal of the American Medical Association publication on a three tiered approach to regulating ACOs.

Accountable Care Organizations & Criteria For Piloting Them in the House Reconciliation Bill: Include Disease Management & the PCMH discusses the House's health reform bill's original language on ACOs and the prospects for disease management and the patient centered medical home.

A Marriage Made in Heaven? Accountable Care Organizations, Patient Centered Medical Homes and the New England Journal. The DMCB Says Not So examines and links a NEJM article on the topic and adds some additional recommendations: 1) more research, 2) survey community-based physicians about the PCMH, 3) link payment and quality and 4) explore combined disease management-PCMH models.

Accountable Care Organizations: The Good, the Bad and the Better Thanks to Health Affairs looks at pro and a con postings on ACOs on the Health Affairs Blog web site.

The Patient-Centered Medical Home & the Accountable Care Organization: Two Sides of the Coin is a posting by none other than IBM's Paul Grundy on the synergies of ACOs and the PCMH.

Accountable Care Organizations (ACOs): A 'Blue Ocean' for the Disease Management Industry? looks at the important business opportunities for disease management organizations within ACOs.

Fragmented Systems Don't Mean Fragmented Care: What Accountable Care Organizations Can Learn From Employer-Purchasers checks out a newsletter from the Commonwealth Fund on how self-employed insurers can coordinate the pieces of population-based care. The same is true, by the way, for ACOs.

Specialist Physicians and Patient Centered Medical Homes: Here's How To Make It Work looks at the issue of specialist clinics acting as 'medical homes' and asks if, thanks to 'transorganizational support,' that could work inside ACOs.

The Decline of Small Physician Owned Practices Explained.... and a Prediction That Private Practice Will Hang In There looks at the phenomenon of large consolidated independent practices and how, in an ACO "scramble," they will interact with multiple hospitals.

Would You Want To Do Business With Medicare Under These Two Scenarios? Looks at the Medicare Coordinated Care Demo's data and asks if ACOs could turn out to have a Feds-we-win, provider-you-lose outcome.

Vermont's Foray Into Accountable Care Organizations: An Update From The Commonwealth Fund Discusses an article on the Commonwealth Fund website that has an update about Vermont's ACO pilot - this is the one that involves FFS Medicare.

Moving From Volume-Driven Medicine Toward Accountable Care is a pro-ACO Health Affairs Blog posting by former CMS Administrator Mark McClellan. Jeff Goldsmith posts a contrarian companion piece titled The Accountable Care Organization: Not Ready for Prime Time.

(New!) Ten Inconvenient Possible Downsides to Accountable Care Organizations: Details, details outlines ten obstacles between here on the long road to ACO-dom.

(New!) The DMCB examines an article by uber economist Robert Berenson that offers three suggestions to reduce the perception that ACOs are an upside-risk-only lottery.

Links to the peer reviewed literature on the topic:

Shortell SM, Casalino LP: Implementing Qualifications Criteria and Technical Assistance for Accountable Care Organizations. JAMA 2010;303(17):1747-1748

Fisher ES, Staiger DO, Bynum JPW and Gottlieb DJ: Creating Accountable Care Organizations: The Extended Hospital Medical Staff. Health Affairs 2007;26 (1):w44-w57

Casalino LP, Rittenhouse DR, Gillies RR, Shortell: Specialist Physician Practices as Patient-Centered Medical Homes. New Engl J Med 2010;362(17):1555-1558

Rittenhouse DR, Shortell SM, Fisher ES: Primary care and accountable care - two essential elements of delivery-system reform. New Engl J Med 2009;361:2301-2303

Luft, HS: Becoming accountable - Opporunities and obstacles for ACOs. New Engl J Med;2010: 363:1389-1391

(New!) Berenson RA: hared Savings Program for Accountable Care Organizations: A Bridge to Nowhere? Am J of Managed Care 2010;16:721-726

Other health reform links:

AMEDNews: Accountable care organizations: A new idea for managing Medicare

The Patient Protection and Affordable Care Act


Bradley Dean Stephan said...

I thank the DMCB for compilating this information, but I was somewhat surprised at the paucity of articles on this, admittedly, emerging topic. As a fan of the ACO concept, let me share my little oped piece published this week in our local paper:

My humble, starry-eyed prediction for ACOs: As they innovate, mature and operationalize their place in the world, in particular their health management and outcome-based reimbursement systems, I see them supplanting insurers, which will then transition from marketing organizations to backroom administrators and investors.
Brad Stephan

Jaan Sidorov said...

Thanks for sharing Brad. I also checked out the article and it brings up some important points, especially about being the passenger or the driver.

In the meantime, the demise of health insurers and independent physician owned practices has been repeatedly predicted. Time will tell.