Roundup: ACO Proposed Rules Fuel Uncertainty

From the payer perspective, America’s Health Insurance Plans President and CEO Karen Ignagni also expressed concerns about antitrust provisions needed to protect insurers from “the trend of provider consolidation that drives up medical prices and result in additional cost-shifting to families and employers with private coverage.”

As for providers, before they can begin to create ACOs, they have to realize who such entities are accountable to. "The accountability is not unilateral; it's trilateral, for the management of care across locations and time," Tom Enders, managing director of CSC's Health Sector Group in New York told HealthLeaders Media last fall. Then they must decide whether the potential cost savings worth the effort to establish an ACO.

Among the potential pitfalls recognized by the federal government are the legitimate antitrust concerns from payers and providers. So the feds piggybacked onto the ACO guidelines a separate proposal calling for expedited antitrust reviews and designated antitrust "safety zones" for some ACOs. “The Administration has led an unprecedented, collaborative effort among all of the agencies responsible for developing guidance for ACOs," said Federal Trade Commission Chairman Jon Leibowitz. "This guidance will help ensure that ACOs meet their goals of improving quality and lowering costs while minimizing the regulatory burden on healthcare providers."

Paul Keckley, executive director of the Deloitte Center for Health Solutions, said he was impressed by the federal government’s “deliberate process” of crafting guidelines for an extremely complex proposal that has the potential to revolutionize healthcare delivery and outcomes. “The amount of effort they built into calibrating the quality metrics, the indices of the five domains, the waivers, the safety zones, the antitrust issues. They were pretty thoughtful about balancing all of those moving parts of what is a pretty complicated concept," he told HealthLeaders Media.