The final regulations also reaffirm certain features of Medicare ACOs, says Sharon Siler, director of healthcare networks for Washington, D.C.-based Avalere Health.
The added good news for health plans is that the features align with many of the operational functions, and management tools and processes that health plans already have in place, such as:
On the flip side, Siler says health plans need to be concerned that the new rules may weaken antitrust protections. She explains that the proposed rules issued in April 2011 required all ACOs to participate in an antitrust review as one way to ensure that an ACO wouldn't limit competition by dominating a market and having an adverse affect on reimbursement rates.
The final rules make the antitrust review voluntary. Siler says that means there will not be a way to stop providers from being so large that they shift the balance of financial power completely to their side. "Payers and employers are very worried that this will create a situation where they have no control over costs," she said.