Accountable Care Organizations (ACOs)

An accountable care organization (ACO) is type of managed care organization in which physicians, hospitals and other providers takes responsibility for the health and wellness of a population of patients, including responsibility for high quality, appropriateness, and efficiency of the care provided.

AMGA Letter to Berwick: 93% of AMGA physician organizations won’t participate as ACOs without major changes to draft regs

ACO Reimbursement and Gain Sharing /

In a May 11th letter to CMS Administrator, Dr. Don Berwick, the American Medical Group Association (AMGA) President, Don Fisher, complained that the draft regs for the Medicare Shared Savings Programs were “overly prescriptive, operationally burdensome, and the incentives are too difficult to achieve to make this voluntary program attractive.” In particular, Fisher mentioned concerns

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How does behavioral economics and “gamification” relate to ACOs?

ACO Reimbursement and Gain Sharing, Behavior Change /

The transformation of our health care system requires many different people to change their behaviors. Leaders of health care organizations have to be willing to make investments that they have historically not been willing to make. Physicians have to change the way they relate to patients, the way they interact with their non-physician team members

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Part 1 of Critique of Milliman’s Whitepaper on Non-Medicare ACOs: Misinterpreting the Milliman “Well Managed” Actuarial Model?

2 Comments / Accountable Care Organizations (ACOs), Modeling Methods /

Victoria Boyarsky, Howard Kahn, David Mirkin, and Rob Parke from Milliman recently released a Healthcare Reform Briefing Paper entitled “ACOs beyond Medicare.” In the paper, the authors argue that the Medicare Shared Savings Program (and the associated regulations regarding the formation of ACOs), as defined in the draft regulations released on March 31, 2011, will

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Interesting “National Strategic Narrative” on Prosperity and Security and how it relates to health care transformation

ACO Culture /

This morning I read a short article by my favorite journalist, Fareed Zakaria (who I have been reading since long before he was a CNN news celebrity).  In the article, Zakaria covers and expresses his general agreement with a policy paper published by the Wilson Center proposing a new “National Strategic Narrative” regarding prosperity and security.

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Explaining alternative types of ACO structures: How do Co-Management arrangements and Hospitalists fit in?

ACO Strategy, ACO Structure & Governance /

All across the country, physicians and hospitals are talking to each other about creating new organizational structures to enable them to work together more effectively.  Some are trying to create Accountable Care Organizations (ACOs) or Organized Systems of Care (OSCs) to participate in the Medicare Shared Savings Program or similar programs being launched by commercial

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Links to CMS ACO Proposed Rules and Dr. Berwick’s associated NEJM comments

1 Comment / ACO Reimbursement and Gain Sharing, Bibliography /

After much delay, the Federal Government has finally released the following: 427 page  “notice of proposed rule-making” from CMS covering Accountable Care Organizations (ACO) and the associated Medicare Shared Savings Program 26 page document regarding the “waiver designs” for the Shared Savings programs and the Innovation Center A short “perspective” piece in the New England

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NEJM report of ACO financial model fails to include risk of delayed start on transformation

3 Comments / ACO Reimbursement and Gain Sharing, ACO Strategy, Cost-Effectiveness Analysis (CEA), Decision Analysis /

On March 23, 2011, Trent Haywood, MD, JD, and Keith Kosel, PhD, MBA published the results in the New England Journal of Medicine (NEJM) web site of a financial model of a hypothetical Accountable Care Organization (ACO).  This model shows that ACOs are likely to lose money on the Medicare Shared Savings Program called for in

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“Can I get a Fast Pass?”: Learning from Disney about health care quality

1 Comment / ACO Culture, Lean Thinking /

While returning from a vacation to Walt Disney World yesterday, my family and I were in a disorganized crowd at the Orlando International Airport boarding the tram that shuttles travelers between terminal buildings.  A man yelled “Can I get a fast pass?”  Everyone laughed. Anyone who has been to a Disney park knows that a

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Atul Gawande’s articles in the New Yorker most relevant to ACOs

1 Comment / ACO Culture, Bibliography, Clinical Process Improvement /

Atul Gawande is a general surgeon at Brigham and Women’s Hospital in Boston, and is an amazingly compelling writer about health care issues.  He has written a series of articles in the New Yorker, blending stories of individual patients and their care providers with a larger scientific and health policy context.  Some of the most relevant of

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ACOs must steer clear of anti-trust issues

1 Comment / ACO Structure & Governance, Opportunity Analysis /

What’s the problem? Accountable Care Organizations (ACOs) involve the creation of new entities that are intended to improve quality and efficiency of care.  But, experts in economics and anti-trust law worry that ACOs can have the unintended effect of reducing competition among health care providers, creating local monopolies that can drive up prices. In a

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