Tom Emerick pushed this out today from his excellent blog (http://crackinghealthcosts.com/index.php/2013/02/aca-inspired-acos-doomed-to-fail/), but it deserves another push. In fact, it deserves as many pushes as it can get. The Accountable Care Organization (ACO) is a critical piece in the projected long-term success of the Affordable Care Act. Like many health care concepts before it, there is more uncertainty about it than there is certainty.
This essay in the Wall Street Journal today does an excellent job of summarizing some of the potential pitfalls, which the ACA’s proponents appear to have glossed over. Unfortunately, the obstacles are so basic and so fundamental, that it’s hard to envision the success of any ACO unless these issues are addressed forthrightly.
I will never forget sitting in a conference room with the senior staff of a huge health system, which will run an ACO, as they bandied about essential issues in managed care, disease management, and wellness. It was sad, and more than a little disconcerting, to watch senior managers who’ve come up through the ranks in the modern managed care era, struggle to define terms such as at-risk, capitation, and risk sharing. The essay authors concentrate on physician behaviors that are deeply ingrained after decades of learning how to live with modern managed care pressures; what of administrators (many of whom are richly compensated and surprisingly illiterate in basic health economics and principles of population health)? They will administer the ACOs and other magic bullets that evolve in the years to come. Upon what history of successful administration of the medical care system will we rest our hopes with them? It is a very precarious ledge, indeed.