Dueling JAMA articles judge whether ACOs have been successful

In response to the view of two Duke University professors who claimed accountable care organizations (ACOs) “have failed to produce needed efficiencies,” another JAMA Viewpoints article defends the ACO model and encourages CMS not to abandon it.

The response comes from Zirui Song, MD, PhD, of Massachusetts General Hospital, and Elliott Fisher, MD, MPH, director of the Dartmouth Institute for Health Policy and Clinical Practice. They argue there is limited evidence on the effects on ACO contracts, and what evidence exists suggests the model can lead to modest savings. What could be more compelling, Song and Fisher write, is the benefits to quality achieved through ACOs.

“This evidence provides grounds for cautious optimism,” their article states. “That quality is improving substantially could be consistent with the notion that even weak incentives can change behavior when they are aligned with core professional values.”

Rather than end ACO experiments and focus on telemedicine and wearable devices, as Duke University professors Kevin Schulman, MD, and Barak Richman, JD, PhD, advocated, Song and Fisher argue there are broader problems with value-based care that need to be addressed. The challenges they identify include incentives too weak to encourage physicians to assume more risk, hospitals’ reluctance to “right-size” their industry and perhaps wishful thinking from doctors and hospitals that fee-for-service payment will remain the norm.

For more on how Song and Fisher propose to tackle these challenges, click on the link below: