If the ACO Idea Fails, What’s Next?

By Gregg A. Masters, MPH

In the sea of collective opinion via both pundit and ‘boots on the ground do’ers’ reported in trade group, popular and growing insights proffered via social media, one of the narratives centers on can ACOs really make a difference? In other words, is meaningful reform of the failing volume driven finance and delivery system paradigm possible, i.e., can ‘they’ enable the real time fulfillment of the triple aim? Further, are these growing, variably expressed and evolving ‘ACO vehicles’ [of the regulated government variety, as well as its many private/commercial mutations] both necessary and sufficient to achieve what has been an historically elusive goal?

For some reflection, in today’s conversation alone via Kaiser Health News, I am struck by the title ‘Are ACOs Doomed To Fail?‘ as somewhat of an headline ‘eye porn’ invitation to engage one’s cerebral matter in the question.

This is a timely and reasonable question, so do read the article and judge for yourself. See if you agree with the professors’ call:

ACOs in the end are going to end up costing more money and not necessarily deliver on the quality either.

For an abstract of the Health Affairs article, click here.

My take is this sound-byte headline and associated conclusion represent the school of narrow thinking too often derived from academics’ and health policy wonks typically fueled with a graduate school of business ‘market’ orientation vs. a sustainable public health ‘ecosystem’ perspective.

Yet, perhaps a better dialectic is witnessed in the observation, question and subsequent answer offered by [Kaiser] Permanente’s Federation founding Chief Executive, Jay Crosson, MD at the 3rd National ACO Congress:

To wit, Dr. Crosson suggests a future not unlike the looming dramatic reduction approaching 27% to the Medicare fee schedule via ‘sequestration’:

Bottomline, the days of containing ‘solution-speak’ to internal squabbling among healthcare leadership (both provider and payor communities) are over. The collective industry failure, exceptions notwithstanding, to re-engineer our costly and to many inaccessible healthcare assets and coverage is now a macro economic issue that threatens the U.S. if not entire global economies.

So is it different this time? Or are we just ruminating on ‘much to do about nothing’ one more time? I say no. It is different. We all have skin in this game. ACOs and their ‘accountable care’ derivatives are here to stay. If they fail, ‘game-over’ and the government steps in with a with single payor solution [the good, the bad, and the ugly et sequelae]. No more private/public partnership ‘bites at the apple’ so to speak, so let’s ‘get er done.’


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