Planning Accountable Care Organizations

Nov 1 2010

American Medical News: "The National Committee for Quality Assurance is seeking input from the public on draft accountable care organization standards," which "were drafted by the organization's Accountable Care Organization Task Force comprising representatives from large integrated health care systems, academia and the insurance industry. … Establishing ACOs for Medicare and Medicaid beneficiaries is a key part of health system reform legislation" (11/1).

Modern Healthcare: California's experience with ACOs may help predict whether accountable care organizations, which "bring together providers and then reward them for taking responsibility for the quality of care for their patients while controlling costs," will work under the Affordable Care Act. "In California, many providers have been working in ACOs for decades, and they say they can work well—although there are pitfalls and limitations." Currently, around "half of insured Californians receive their care through some type of ACO." According to one expert, California's experience demonstrates that "[a]ligning incentives and strong leadership are more important than the actual institutions;" that "varied payment mechanisms, instead of a one-size-fits-all approach, such as capitation" are important; and that "ACOs must not be fixed to only one insurance type." A pressing question is whether care coordination can "work in a PPO environment where consumer choice reigns. … Pilot projects are under way in California that seek to collaborate among providers and payers across business lines"  (Vesely, 11/1).