Medicare ACOs Move Closer to Commercial Model Under Final Rule

Margaret Dick Tocknell, for HealthLeaders Media , October 21, 2011

In a statement, Karen Ignagni, president of America's Health Insurance Plans, said that the program takes important steps towards achieving greater accountability and better quality care." She added, however, that the organization remains "concerned about the trend of provider consolidation that drives up medical prices and results in additional cost-shifting to families and employers with private coverage."

"The initial regulation," Ignagni said, "created an antitrust screening mechanism that would have protected consumers with a mandatory up-front antitrust review and exclusion from the program for those ACOs facing a legal challenge.  Doing away with the mandatory review process raises concerns that provider market power may not be scrutinized sufficiently, potentially increasing health care costs for consumers and employers.

AHIP , which filed in June a 20-page comment letter on the proposed ACO regulations, declined to comment on how the final regulations address the specific concerns expressed in that letter. "We are still going through the regulations and will have additional comments in the future," explained Robert Zirkelbach, press secretary for AHIP.

While the final regulations hold promise for health plans, Siler said that as stakeholders have a chance to completely review the 626-pages of regulations they may discover that "CMS has made this an easier pill to swallow, but it's still difficult to digest."

Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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