By Gregg A. Masters, MPH (inspired by Vince Kuraitis)
e/n/t/e/r/p/r/i/s/e/ = A business (also known as enterprise or firm) is an organization engaged in the trade of goods, services, or both to consumers… The etymology of “business” relates to the state of being busy either as an individual or society as a whole, doing commercially viable and profitable work. – WikiPedia
Yesterday I had the pleasure of chatting with Andrew Croshack and Thomas Merrill of Leavitt Partners, aka @LeavittPartners, the consulting firm founded by former Bush Administration Secretary of HHS and EPA Administrator, Michael O. Leavitt. We discussed their recent report ‘Growth and Dispersion of Accountable Care Organizations‘.
Upon review of the document, and perhaps due to my UCLA forged public health genealogy, I instinctively substituted common epidemiology notions of ‘incidence and prevalence’ v. the growth and dispersion of ACO’s characterization. Not sure why, just an autonomic reponse (thanks professor/dean Detels). I suppose it remains to be seen whether the neo-clinical and underlying public health pathology implied will in fact materialize as de facto business or enterprise equivalents akin to the rise and fall of the physician practice management company industry (PPMC).
None-the-less, Croshaw posits as motivation to conduct the survey the absence of empirical data on the growth of the industry. Their reported results by ‘sponsor’ are summarized as follows:
Of the 164 identified ACOs, the sponsoring entities included hospital systems, physician groups and insurers with a market presence in 41 states but less than half of all HRRs. Of these entities, 99 were primarily sponsored by hospital systems, 38 by physician groups and 27 by insurers.
Yet following a review of their report and our conversation, noted industry observer and talented consultant Vince Kuraitis further opined on their methodology, specifically questioning their omission to distinguish between ACOs and ‘accountable care’ per se. Kuraitis offers the following:
Are the Findings Accurate?
I’ve written before about the critical distinction between “accountable care” and ACOs — they’re not the same thing. If there is one suggestion I would offer the Leavitt researchers, it’s that the next census should better distinguish between formal ACOs and other accountable care-like (AC-Like) activities.
A formal ACO organization is a legal entity formed by care providers — it is incorporated, has a Board, holds meetings, is registered with the Secretary of State.
Informal, AC-Like initiatives can be created through contracts. The parties simply get together and agree to develop an initiative. They might choose to announce or not to announce their initiative publicly. Commercial payers are much more likely to be involved in AC-Like activities — in many cases even leading the charge.
How accurate is the Leavitt census of ACO activity? I can see that it has potential both to overstate and understate accountable care initiatives.
Kudos to both Vince and Andrew et al for kicking off this conversation, and comments are most welcome here and there as well. Yes, there is little empirical data available and for good reasons noted in both narratives. I highly recommend you read both the Leavitt Partners report, and Vince’s follow-up thoughts to further develop your own perspective.