Could Health Plans Derail ACOs?
AHIP is calling attention to anything and everything that could potentially run afoul of antitrust laws such as prohibitions against physician self-referrals, anti-kickback statutes and civil monetary penalty laws. And it appears the group has some unlikely allies in smaller physician groups who could be left out of the ACO mix as well as consumer advocates who fear that powerful ACOs could limit choices and raise costs.
At the moment, the health insurance industry is being diplomatic saying that it supports the ACO concept as a way to "improve quality and reduce costs for consumers and payers alike," provided regulators allow the exploration and formation of a wide range of structural models. It's even shown willingness to go so far as supporting special "narrowly tailored" exceptions such as safe harbors, waivers, or advisory opinions that would allow beneficial ACOs to skate through antitrust regulations.
But if a health insurance industry that's already irritated by ACA pressures gets even a whiff of impropriety by ACOs, expect it to recall attention to stiff price fixing and collusion laws that have brought down many greats (think Kodak and AT&T).
The ACO has a place in healthcare's future if there is a balance in power between providers and payers. Let's just hope federal regulators can get this tricky issue right.
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