ACO Creation Driven by Commercial Market

Philip Betbeze, for HealthLeaders Media , April 29, 2011

Almost offhandedly, they would continually mention pilot programs embedded in their commercial payer contracts that are a mix of innovative ways to measure value and healthcare quality. There's a kaleidoscope of programs to do this work, and some of them are mentioned in the story, but I think the overall takeaway from this trend is that it's not just the cash-strapped and debt-ridden federal government that recognizes there is a problem with the way healthcare is provided and paid for under the fee-for-service system.

This is a positive sign. It means that unlike in the past, most healthcare organizations are looking for ways to become more efficient and provide more value for the huge sums of money spent on interventions. Maybe they finally believe that in the future, after years of warnings, that healthcare cost increases will be unsustainable and tightly contained via a variety of tools that might or might not have anything to do with how the biggest payer, the government, structures things.

To be sure, most of these programs will undergo changes yearly as payers and providers search for ways, and occasionally butt heads, over what constitutes 'value-added' interventions. But this is happening right now, in 2011, rather than in 2014 or 2019.

That in itself is a reason for optimism.


Philip Betbeze is senior leadership editor with HealthLeaders Media.

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