From the Editor | Are ACOs Disruptive Enough to Change the System?
Are we standing at the threshold of a major change in the nation's healthcare delivery model? With the rules for accountable care organizations (ACOs) finally out, we examine some early models for accountable care organizations in the story on page 18. Two phrases came up repeatedly in the interviews for this article: "disruptive technology" and "unintended consequences." Some conflicting analysis was to be expected and the buzz hasn't died down much, if at all, since the proposed rules were released. After all, these care delivery and payment models are intended to transform healthcare as we know it. But to what degree will that happen, and what direction will ACOs take?
A disconcerting commentary in the Journal of the American Medical Association in late April raised the possibility that ACOs, as currently proposed, might actually stratify or worsen some of the inequities in healthcare among poorer communities versus more affluent areas of the nation. More well-off practices would be more sought-after as partners for accountable care relationships, the authors argue, and wealthier hospitals are probably better able to compete for these services. In addition, the proposed rules for ACOs could be interpreted to prevent federally qualified health center patients from participating in the Medicare Shared Savings Program, warns the Geiger Gibson/RCHN Community Health Foundation Research Collaborative.
Literature also suggests that more educated (read that wealthier) populations are more inclined to practice behaviors associated with "wellness" and prevention of chronic conditions. Generally, these patients will be less costly to the medical system.
Even so, a New England Journal of Medicine study indicates shared savings would be hard for any ACO network to achieve within the first three years of operation—even organizations that already are providing some aspects of ACO-style care.
Left unexplored are the implications for patients and providers if enough ACOs fail. Will fee for service again be the model for most care? There also is the possibility that these organizations might consolidate to achieve additional savings—and where would that leave the providers and patients?
Roughly a month before the proposed ACO rules were released, the Agency for Healthcare Research and Quality released the 2010 National Healthcare Quality Report and National Healthcare Disparities Report, which found that access is still uneven and disparities exist, especially for minority and low-income groups. "The gap between best possible care and that which is routinely delivered remains substantial across the nation," the report states.
This is both a compelling reason to pursue new ways of delivering care and a warning to keep a close eye when implementing these new ways.
A disconcerting commentary in the Journal of the American Medical Association in late April raised the possibility that ACOs, as currently proposed, might actually stratify or worsen some of the inequities in healthcare among poorer communities versus more affluent areas of the nation. More well-off practices would be more sought-after as partners for accountable care relationships, the authors argue, and wealthier hospitals are probably better able to compete for these services. In addition, the proposed rules for ACOs could be interpreted to prevent federally qualified health center patients from participating in the Medicare Shared Savings Program, warns the Geiger Gibson/RCHN Community Health Foundation Research Collaborative.
Literature also suggests that more educated (read that wealthier) populations are more inclined to practice behaviors associated with "wellness" and prevention of chronic conditions. Generally, these patients will be less costly to the medical system.
Even so, a New England Journal of Medicine study indicates shared savings would be hard for any ACO network to achieve within the first three years of operation—even organizations that already are providing some aspects of ACO-style care.
Left unexplored are the implications for patients and providers if enough ACOs fail. Will fee for service again be the model for most care? There also is the possibility that these organizations might consolidate to achieve additional savings—and where would that leave the providers and patients?
Roughly a month before the proposed ACO rules were released, the Agency for Healthcare Research and Quality released the 2010 National Healthcare Quality Report and National Healthcare Disparities Report, which found that access is still uneven and disparities exist, especially for minority and low-income groups. "The gap between best possible care and that which is routinely delivered remains substantial across the nation," the report states.
This is both a compelling reason to pursue new ways of delivering care and a warning to keep a close eye when implementing these new ways.