HMO 2.0 - Which Comes First: Healthcare Reform or Payment Reform?
The term ACO is attributed to Dr. Elliot Fisher, well-known for his Dartmouth Atlas Project which demonstrates the wide variation in cost per Medicare beneficiary across the country as well as the lack of correlation between cost and quality (higher cost does not translate to higher quality). In an effort to correct this trend, ACO pilot projects are already in the works, including Medicare as a result of the passage of the PPACA.
- The Dartmouth Institute for Health Policy and Clinical Practice and the Engelberg Center for Health Reform at Brookings Institution are set to implement a pilot project sometime in 2010.
- Highmark, the Pittsburgh based insurer, is reportedly in the early stages of implementing a version of capitation-based payment called “global payments” with several regional rural health systems.
Some of the primary goals of an ACO are to coordinate care across healthcare providers and control costs. Determining the proper organization will be difficult, especially where physician-hospital relationships are strained. However, controlling costs has always been the greatest challenge. It seems that the "chicken or the egg" quandary persists - can you have healthcare reform without payment reform first? Or - is it the other way around?
Here's an excellent paper about the pilot projects near launch in Vermont:
http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2010/May/The-Vermont-Accountable-Care-Organization-Pilot-A-Community-Health-System-to-Control.aspx
Provided by Kim Byas of the American Hospital Association.