Published: 2009-10-25 16:40:43
Author: Michelle Andrews | New York Times | October 9, 2009
Experts largely agree on the need to change how health care providers are paid. Currently, most are reimbursed for every service they provide, but so-called fee-for-service payment systems do little to encourage cost control or, since often no one provider is in charge, to effectively coordinate patient care.
Now a new approach that aims to do a better job of “aligning incentives,” as the wonks like to say, has grabbed the attention of policy experts and legislators. The “accountable care organization” is a health care model in which doctors and hospitals agree to take joint responsibility for keeping patients healthy and to share in any financial benefits that result.
Health care bills pending in the Senate Finance Committee and in the House would create pilot A.C.O. programs for Medicare and Medicaid providers. Three private sector pilots will begin testing the concept in January, a joint project of the Dartmouth Institute for Health Policy and Clinical Practice and the Brookings Institution’s Engelberg Center for Health Care Reform.
Integrated health systems that are organized into “one-stop shops” for patient care — like Geisinger Health System in rural Pennsylvania and the Cleveland Clinic — may in some instances already provide the cost-effective, coordinated care of an A.C.O. But these kinds of organizations are rare. Many policy experts believe that similar results could be achieved if physician practices and other medical practitioners partner with local hospitals to form A.C.O.’s.
“Most people get care not from formal care organizations but from informal care networks, and we want to support that structure,” said Elliott Fisher, director of health policy for the Dartmouth Institute for Health Policy and Clinical Practice.
Though remaining separate, the participants would agree on a mechanism to permit joint decision-making. Participating providers would agree to per-patient health care spending targets and quality goals, and then divvy up any savings that they achieve or receive a bonus. This arrangement would give unrelated health-care providers an incentive they previously lacked to make sure patients get coordinated, cost-effective care.
In the Senate Finance Committee’s proposed Medicare program, for example, a spending baseline would be set for beneficiaries in a particular A.C.O by using the three previous years’ spending levels. The target spending level that providers would aim for would be the baseline plus a flat dollar amount based on national average spending growth, adjusted for health status.
To those who follow the twists and turns of health policy, this may sound a lot like the “capitated” payment structure characteristic of managed care in the 90s, which resulted in a consumer and provider backlash. Are A.C.O.’s really just H.M.O.’s for the new millennium?Full story