Accountable Care Organizations — The Fork in the Road

Greaney, Thomas L.

doi:10.1056/nejmp1013404

Cited by 41 publications

(22 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…New proposals to support the launch of accountable care organizations (ACO) and medical homes are formulated on an almost monthly basis, with payment reform as a central component [1][2][3][4][5]. This evolution embodies a shift across western health systems away from traditional payment systems, such as fee for service (FFS) or salary toward wide scope prospective payment systems with risk sharing and an incorporation of clinical evidence and quality indicators in provider payment [6][7][8][9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Healthcare payment reforms across western countries on three continents: Lessons from stakeholder preferences when asked to rate the supportiveness for fulfilling patients’ needs

et al. 2013

View full text Add to dashboard Cite

Objective. To test the hypothesis that care typology -being complex and highly unpredictable versus being clear-cut and highly predictable -guides healthcare payment preferences of physicians, policy makers, healthcare executives, and researchers.Data Sources/Study Setting. We collected survey data from 942 stakeholders across Canada, Europe, Oceania, and the United States. Forty-eight international societies invited their members to participate in our study. Study Design.Cross-sectional analysis of stakeholder survey data linked to four scenarios of care typology: primary prevention, trial-and-error care, standard care and network care.Principal Findings. We identified two "extremes": (1) dominant preferences of physicians, who embraced fee for service (FFS), even when this precludes the advantages of other payment systems associated with a minimal risk of harm (OR 1.85 for primary prevention; OR 1.89 for standard care, compared to non-physicians); and (2) the dominant preferences of healthcare executives and researchers, who supported quality bonus or adjustment (OR 1.92) and capitation (OR 2.05), respectively, even when these could cause harm. Conclusions.Based on explorative findings, we can cautiously state that payment reform will prove to be difficult as long as physicians, healthcare executives, and researchers misalign payment systems with the nature of care. Replication studies are needed to (dis)confirm our findings within representative subsamples per area and stakeholder group.

show abstract

Section: Introductionmentioning

confidence: 99%

Healthcare payment reforms across western countries on three continents: Lessons from stakeholder preferences when asked to rate the supportiveness for fulfilling patients’ needs

et al. 2013

View full text Add to dashboard Cite

show abstract

“…PPOs are typically managed more loosely than are HMOs ACOs involve both vertical and horizontal cooperation, which could increase market power and raise antitrust concerns. 2 Higher prices or lower quality for private health plans is a possible outcome (Scheffler et al 2012; Federal Trade Commission/Department of Justice 2011; Berenson et al 2010;Greaney 2011;Cuellar and Gertler 2006). Medicare sets prices, so the use of market power against Medicare primarily affects non-price dimensions such as amenity, quality, and access (Kessler and McClellan 2000;Gaynor et al 2013).…”

mentioning

confidence: 99%

Market Power, Transactions Costs, and the Entry of Accountable Care Organizations in Health Care

et al. 2015

View full text Add to dashboard Cite

ACOs were promoted in the 2010 Patient Protection and Affordable Care Act (ACA) to incentivize integrated care and cost control. Because they involve vertical and horizontal collaboration, ACOs also have the potential to harm competition. In this paper, we analyze ACO entry and formation patterns with the use of a unique, proprietary database that includes public (Medicare) and private ACOs. We estimate an empirical model that explains county-level ACO entry as a function of: physician, hospital, and insurance market structure; demographics; and other economic and regulatory factors. We find that physician concentration by organization has little effect. In contrast, physician concentration by geographic site-which is a new measure of locational concentration of physicians-discourages ACO entry. Hospital concentration generally has a negative effect. HMO penetration is a strong predictor of ACO entry, while physician-hospital organizations have little effect. Small markets discourage entry, which suggests economies of scale for ACOs. Predictors of public and private ACO entry are different. State regulations of nursing and the corporate practice of medicine have little effect.

show abstract

“…1 Observers are expressing concern, however, that newly established ACOs are joining health care organizations that otherwise would compete with each other, thus creating networks with dangerous market power. 2 It appears that the main purpose of health care entities in forming ACOs may not be to achieve cost savings to be shared with Medicare but to strengthen negotiating power over purchasers in the private sector.…”

mentioning

confidence: 99%

A Cautious Path Forward on Accountable Care Organizations

Richman

2011

JAMA

View full text Add to dashboard Cite

Accountable Care Organizations — The Fork in the Road

Cited by 41 publications

References 1 publication

Healthcare payment reforms across western countries on three continents: Lessons from stakeholder preferences when asked to rate the supportiveness for fulfilling patients’ needs

Healthcare payment reforms across western countries on three continents: Lessons from stakeholder preferences when asked to rate the supportiveness for fulfilling patients’ needs

Market Power, Transactions Costs, and the Entry of Accountable Care Organizations in Health Care

A Cautious Path Forward on Accountable Care Organizations

Contact Info

Product

Resources

About