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ACO Creation Driven by Commercial Market

Philip Betbeze, for HealthLeaders Media, April 29, 2011

Yes, you read that headline correctly. Although what constitutes an accountable care organization has been defined, at least temporarily, by CMS, many of the forces that are actually doing the work of pushing hospitals, health systems, and allied health providers, into ACOs is being done by commercial insurers.

Of course, to change the way they pay for healthcare takes only a decision by an individual company. The feds, on the other hand, must go through revisions, public comment periods, and a phased-in restructuring of payments and incentives that will take years.  

Commercial payers aren't waiting.

They're not calling these programs ACOs, and they're not, in the sense that they meet a government-decreed standard of care. But whatever you call them, they're making healthcare providers more accountable for patients' overall health. So while the government's work is glacial, by comparison, commercial contracting's work on accountable care is lightning-quick.

I came to this realization as I interviewed senior leaders from hospitals and health systems for this month's cover story in HealthLeaders magazine. I started by asking questions about whether my sources were planning on being ACOs as the government defines them. Most of them weren't sure, but they certainly had their own plans in place, and were executing on them, to be accountable for patients' health, simply because their payers were demanding it.

Though many of them were highly interested in what the regs for ACOs would be (I conducted my interviews in late March, well ahead of the release of the proposed federal ACO regs) many of my sources weren't spending too much time worrying about the specifics.

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