ACOs' Real Test Will Come with Two-Sided Risk

The announcement this week of 89 Accountable Care Organizations is like a college acceptance letter: Great work so far, you got in, now the real work begins. The project's viability will be proved only when ACOs have to sign up for their second contracts, which will require two-sided risk.

1 comments on "ACOs' Real Test Will Come with Two-Sided Risk"
Arun K. Potdar, MA-Health Care Mgmt. (7/15/2012 at 11:17 AM)

Philip Betbeze has accurately dignosed the problems ACOs will encounter. Looking at the premise upon which the ACO concept was designed reminds me of bygone days of Staff Model Group Health Plan. When I joined the plan in late eighties it had 165,000 members. In two years it went under with migration of members to Mid Atlantic PPO plan. Controlling patients' choice to a fixed group of care givers had failed miserably. There are two factors responsible for this. First, Physicians by training personality are loners and rarely work together as a team unless it is major project that would bring everyone a Nobel Prize. Second, the leadership in Case Management will be the weakest link in the chain. Ask any senior manager about it if they had worked in a large group practice. It is not clear how the savings will be shared and that again like formulae for profit sharing of a group practice, will have frictions. Patients themselves are driven by outcomes and bedside manners. Any one disappointing member or factor will take them out of ACO. As correctly pointed out in this article; without the risks ACO will have "nothing to lose" attitude. Unless a major paradigm shift in which existing culture of individualistic physician services without sharing, is replaced by a cooperative and team working and coordinating mindsets, ACOs will not give desired savings and will fall apart like the Staff Model HMOs of the past.


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