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May 03, 2010


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Gordon, if one views the ACO via the traditional lens of PHOs or IDN's where the institutional partner is center stage and physician participation is either token or tethered to a majority non physician managing partner, I would say your fears are well founded, I do however believe, there is room enough for granular innovation in the new law particularly as it relates to patient centered medical homes or an aggregated version effectively constituting an ACO or even super/networked ACO.

Love the visual!

See some of my thoughts here: http://2healthguru.wordpress.com/


You are absolutely right on about this, Gordon.

Better care management, and fewer inappropriate procedures, will hurt the hospitals, many of which will need to get smaller and to offer fewer services in the ideal world of appropriate care. The big money makers for the hospitals are the ancillary imaging services, and the emergency rooms that have unrestricted use of these services, without preauthorization. New and high-tech surgical procedures are paid fairly well, but may have no better outcomes than older, more conservative and less costly care. There is tremendous waste when there is unnecessary duplication of services, and no incentive for a hospital to shut down programs it offers just because the hospital down the street has adequate capacity to provide these services.

The only organizations I know of that do reasonably well at this are the staff model HMOs, who own their own hospitals, employ the doctors, and even own the pharmacies. And, they ARE the insurance company, so there there is really a full allignment of interests among all of the participants. But, even successful large organizations (like Group Health Cooperative) took many years developing the culture of "doing the right thing," and it is unlikely that these successes will be duplicated all across the country when they are competing with for-profit and not-for-profit insurance companies and hospital systems.

The idea that large organizations are necessary to provide appropriate, high-quality care is really quite appalling, and the concept of "Accountable Care Organizations" is just one more concept that looks like it might work, but has not been tested. Going down that path may well increase the cost of care for all by increased organizational and overhead cost, without necessarily any improvement in patient-centered outcomes.

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