Mixing up some ACO
No matter what you think about the long-term sustainability of accountable care organizations (ACOs), the Health Affairs Blog argues 2014 will be a short-term watershed year.

The Disease Management Care Blog agrees. As preliminary results like these get reported in 2014, other ACO wannabes will either jump in and create a tipping point, or decide to stay on the sidelines.

According to Leavitt Partners' David Muhlestein, some of the under-recognized ingredients that could influence this include:

Judgments on Generalizability: never mind the marquee brand institutions, it will be results in smaller regional ACOs that lead other physician-hospital organizations to "go" or "no." If the ACO wannabes decide they can replicate other similar systems' success, we'll see more ACOs. If there is no success, the silence could be deafening.

DMCB says... we need more detail.

Whither the Sustainable Growth Rate: years of fee-for-service Medicare payments to physicians may end up being replaced by "value" based payments linked to bonuses. If - and that's a big if - that happens, that could further encourage physicians to join groups. which could prompt the creation of additional ACOs.

DMCB says.... and you thought the SGR was only about physician payments.

Medicaid: It turns out the states may turn to ACOs to increase quality and control costs for their indigent populations.

DMCB agrees.... Governors may see ACOs as a way of mitigating the economic and political risks of expanding Medicaid.

Employers: if ACOs' care coordination and savings are successful, large employees may seek commercial insurers that offer ACOs. Commercial insurers are unlikely to say no.

DMCB says.....never mind Washington DC, how will this play in Peoria?

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