Saturday, December 7, 2013

Accountable Care Organizations

.PPACA does not define who or what can form an accountable care organization.

I may have missed something, but my view was that the organization(s) would be amongst hospitals and their provider group(s) including IPAs. The prevailing concern was who would lead the effort, providers or hospitals ?

Well, fool me as the insurance companies and/or payers  do an end run to possibly score the touchdown and perhaps even the after point.

Originally CMS promoted the idea of accountable care organizationr which would interface with CMS and private insurers would do the same.  It remains to be seen if any of these designs will work to reduce cost, or just reduce care, increase frustration and bureaucracy for the delivery of health care.

During the past several weeks a number of insurance companies (Blue Shield is among the group) have announced formation  of ACOs and are "inviting" their physicians and hospitals to join with their ACO to improve quality of care and reduced costs

No where in PPACA does it state that insurers cannot initiate or direct and ACO. It squarely places the insurer in control of the ACO, who can mandate standards of care.  Was this an intent by omission in the 1300 pages of PPACA?

I would like to think so, however reading PPACA which covers a great deal of minutiae in health reform it is difficult to believe so.

Each day I receive at least ten emails inviting me to a meeting or webinar...usually in the D.C. area. Not many are held in mid country or on the  west coast. National Consultant Organizations and Insurance Industry players charge hefty conference fees and someone is making a fair profit on these meetings. Even the relatively low cost of presenting webinars yield a tidy sum for an archived copy of the meeting on the internet.

ACO's will surely contribute to the increase in health costs to offset whatever ACOs were predicted to save.  True governmental efficiency !
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