ACOs' Real Test Will Come with Two-Sided Risk
The announcement earlier this week that 89 ACOs have been chosen by CMS to serve the healthcare needs of some 1.2 million Medicare beneficiaries is important—but not because it reflects a validation of the process by which the government hopes to get better value for the dollars they spend on Medicare beneficiaries. It doesn't. The news also doesn't reflect a validation of the contention that routing patients through so-called accountable care organizations will save money. It might. Finally, it doesn't mean that the "baseline," on which cost of care growth will be measured (which is yet to be determined, by the way) will be able to balance the reward for cost-limiting with the risk of joining the program.
The ACO announcement is important because it shows willingness by a large percentage of organizations to change their work patterns in order to find ways to better coordinate care for their patients. It's an important first step in an industry that has never had to be judged on results.
In that way, the notice to the 89 is sort of like a college acceptance letter. Great work so far. You got in. Now the real work begins.
The program has proved enticing enough that a large group of providers are willing to join, and that's a good start. But let's not fool ourselves that by signing on with this initial ACO demonstration, providers are enthusiastically looking forward to taking risk on patient outcomes. Because the fact is, most of them aren't taking much risk.