It’s often said that the main method of paying health-care providers—with a fee for each service—results in increased and wasteful spending. Such a system, its critics say, rewards providers just for doing more procedures, rather than for providing efficient and high-quality care.
One major effort to fix that system, promoted by the federal health-overhaul law and some private insurers, is to create accountable-care organizations, or ACOs. Medicare’s main ACO program is launching this year, while many health plans are already working with providers on ACO-style payment models.
To form ACOs, providers typically take on responsibility for groups of patients. Medicare and participating insurers will generally offer financial rewards for ACOs that save money and hit quality goals for these patients. At the same time, ACOs may risk losing money if their costs run higher than expected. The idea is to eliminate duplication of services and coordinate patients’ care, and to boost preventive efforts that may ultimately reduce the need for high-cost services such as hospital stays.
We asked a diverse group of health-care policy experts to discuss, in an exchange of emails, whether ACOs are an answer to what ails the health-care system. Our panelists:
Donald M. Berwick, who stepped down Dec. 2 as administrator of the Centers for Medicare and Medicaid Services. In that role, Dr. Berwick helped oversee the agency’s efforts to structure ACOs created by the federal health-care law.
Tom Scully, the Center for Medicare and Medicaid Services administrator from 2001 to 2004. Mr. Scully is a former chief executive of the Federation of American Hospitals, which represents investor-owned and managed hospitals. He also is currently a partner at Welsh Carson Anderson & Stowe, a private-equity firm in New York.
Jeff Goldsmith is president of Health Futures Inc., a health-care consulting firm, and an associate professor of public-health sciences at the University of Virginia, in Charlottesville.
via What Are Accountable-Care Organizations, and Will They Improve Health Care? – WSJ.com.