Can ACOs Crack the Healthcare Payment Code?

Cora Nucci, for HealthLeaders Media , September 22, 2010

Whether it's called "healthcare reform" or "Obamacare," the multi-year march toward an overhaul of the nation's healthcare delivery system begins this week. Thoughtful people may agree to disagree on the merits of the Patient Protection and Affordable Care Act signed into law six months ago. But the effects it will have on physicians, hospitals, and payers will be stressful for all. Expect some discomfort.

An in-depth analysis published this month by the Intelligence Division of HealthLeaders Media examines the relationship between physicians and hospitals at a critical moment. Healthcare leaders were surveyed for the report just before the first provisions of the new law were about to take effect, while anticipation and speculation about the reform provisions were in high gear.

Those surveyed had one big number on their minds:  32 million. That's the number of people expected to be newly insured between 2014 and 2016 as a result of Medicaid expansion and federally subsidized insurance coverage through soon-to-be-mandated health exchanges.

Here's where the discomfort sets in.  Nearly half of the healthcare leaders surveyed in the HealthLeaders Intelligence Report, Physician Alignment in an Era of Change expect that the increased numbers of insured patients will strain hospital-physician relations. Twenty-two percent said it will have no effect, and 35% said more patients will improve relations.  (Why they thought so is a topic for another day.)

"In my view, these differences simply reflect the fact that some see seismic change as a tragedy and others see it as an opportunity," says Craig E. Samitt, MD, lead advisor for the Intelligence Report.

Indeed, one survey respondent noted that "collaboration between hospitals and physicians will be the only way to survive."  I would add payers to that pair.  Payers—both public and private—are an integral piece of the healthcare system and must be part of any reform-related collaboration.

Comments are moderated. Please be patient.

1 comments on "Can ACOs Crack the Healthcare Payment Code?"

Fred J. Pane (9/23/2010 at 9:13 AM)
There have been collaborative models developed over the years that can be benchmarked, when it comes to ACO's. Geisinger, Intermountain, to name two. They have had collaborative models with their physicians and a focus on prevention and treatment of disease across the continuum. There is one focus, to improve healthcare and the outcomes in patients. That is why hospitals operate (their mission to the community) and it is why physicians and other healthcare providers help patients. It has just been that alignment across the continuum of care, has not been there. It hasnot been there for payers also. It will have to be now. About 7-8 years ago I led a teaching hospital administration group to meet with one of our BCBS providers and on behalf of our PPO. We attempeted a p4p model because of the clinical outcomes and paient safety results we were seeing. The payer had no way to address our model.




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