Having been blessed by the new health reform legislation, accountable care organizations (ACOs) are a hot topic in the health policy world, as evidenced by the just-concluded and well-attended National Accountable Health Care Organization Summit (cosponsored by Health Affairs) in Washington, D.C. Health Affairs has published much of the research and thinking related to ACOs. For example, in the May 2010 issue of the journal, Mark McClellan, Aaron McKethan, Julie Lewis, Joachim Roski, and Elliott Fisher lay out “A National Strategy To Put Accountable Care Into Practice.” The authors address the question of what exactly qualifies as an ACO and provide an update on implementation of ACOs in the context of other reforms, as well as mapping the way forward.
In “Unchecked Provider Clout In California Foreshadows Challenges To Health Reform,” published earlier this year, Robert Berenson, Paul Ginsburg, and Nicole Kemper provide a cautionary tale. California providers have implemented various strategies that have strengthened their leverage in negotiating prices with private health plans. When negotiating together, hospitals and physicians enhance their already significant bargaining clout, the authors note, and they warn that events in the Golden State show that promoting integrated care through models such as ACOs could lead to higher rates for private payers.
In a December 2006 paper titled “Creating Accountable Care Organizations: The Extended Hospital Medical Staff,” Fisher and coauthors Douglas O. Staiger, Julie P. W. Bynum, and Daniel J. Gottlieb provide an empirical foundation for the formation of ACOs. They show that Medicare beneficiaries receive most of their care from relatively coherent local delivery systems comprising physicians and the hospitals where they work or admit their patients. Thus, “the hospital and its extended medical staff provide a natural organizational setting within which to improve the overall experience of care,” they wrote.
Fisher’s 2006 paper was published as part of a six-article package, including articles on hospital-physician relations by Robert Berenson and coauthors and Gail Wilensky and coauthors. The articles prompted a Health Affairs Blog roundtable in which Fisher, Berenson, and Wilensky provided a fascinating discussion of accountable care organizations and other aspects of hospital-physician relationships.
Also on Health Affairs Blog, see an exchange between Jeff Goldsmith (“ACOs: Not Ready For Primetime”) and Aaron McKethan, McClellan, Fisher, and Jonathan Skinner (“Moving From Volume-Driven Medicine To Accountable Care”). And in the journal, see “Fostering Accountable Care: Moving Forward In Medicare,” by Fisher, McClellan, John Bertko, Steven M. Lieberman, Julie J. Lee, Lewis, and Skinner, with a Perspective by Francis Crosson.
Finally, check out “Episode-Based Performance Measurement And Payment: Making It A Reality,” authored last year by Peter S. Hussey, Melony E. Sorbero, Ateev Mehrotra, Hangsheng Liu, and Cheryl L. Damberg. And watch for more on ACOs in the July issue of Health Affairs, to be released on Wednesday July 7.
*** August 2 Update: The latest Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation (RWJF) describes the ACO concept as defined in the recently passed health reform legislation and examines the challenges and opportunities facing health systems, physicians, administrators, insurers, patients, and policy makers as ACOs take shape. In addition, in the July issue of Health Affairs, Stephen Shortell and colleagues suggest that the government create three tiers of qualification criteria for ACOs, which would allow physician practices to assume greater risk and receive larger rewards over time.