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Forget MSSP, You've Already Started a Commercial ACO

Karen Minich-Pourshadi, for HealthLeaders Media, March 5, 2012

"We coordinate the care of our patients as they navigate throughout the entire healthcare system, because we know that patient care includes prevention, chronic care management, acute episodes of care, and post-hospitalization recovery," Cassidy Tsay, MD, MBA, medical director of Greater Newport Physicians, said in a statement.

This partnership, subject to the approval of the California Department of Managed Health Care, is the sixth commercial ACO for Blue Shield of California, which is considered an early adopter of the commercial ACO model.

But is the commercial ACO really new? More than a few healthcare leaders have remarked that the ACO is a rebranded and refined model of pay-for-performance and capitation. That's somewhat true. The biggest difference between P4P/capitation and the ACO model is the joining of all stakeholders at the table (the physicians, the hospitals, and the payers) to all share data to guide better outcomes.

By comparison, in the 1990s the lack of alignment from these stakeholders contributed to the near demise of the capitated model.

Although the model has changed, for years payers have encouraged providers to achieve better patient outcomes, and much of that has occurred through P4P-type initiatives. Many of the payer-provider contracts have monetary incentives associated with them along with participant rankings.

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