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ACOs' Real Test Will Come with Two-Sided Risk

Philip Betbeze, for HealthLeaders Media, July 13, 2012

I hope they do. But the fatal flaw of patient attribution needs to be fixed. None of this can work without patient compliance, and other than the hope that such well-coordinated care organizations will sell themselves to patients and make them want to receive all their care under one roof, there's nothing to compel them to do so.

We'll really find out if this project is viable only when it comes time for ACOs to sign up for their second contracts, which will require two-sided risk. An educated guess based on the initial response is that, without some way to ensure that ACOs have some control over where patients receive care, the risk rules of that second contract might make initial participants think twice.

Until then, success will be gauged only on the hype.


Philip Betbeze is senior leadership editor with HealthLeaders Media.
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1 comments on "ACOs' Real Test Will Come with Two-Sided Risk"


Arun K. Potdar, MA-Health Care Mgmt. (7/15/2012 at 11:17 AM)
Philip Betbeze has accurately dignosed the problems ACOs will encounter. Looking at the premise upon which the ACO concept was designed reminds me of bygone days of Staff Model Group Health Plan. When I joined the plan in late eighties it had 165,000 members. In two years it went under with migration of members to Mid Atlantic PPO plan. Controlling patients' choice to a fixed group of care givers had failed miserably. There are two factors responsible for this. First, Physicians by training personality are loners and rarely work together as a team unless it is major project that would bring everyone a Nobel Prize. Second, the leadership in Case Management will be the weakest link in the chain. Ask any senior manager about it if they had worked in a large group practice. It is not clear how the savings will be shared and that again like formulae for profit sharing of a group practice, will have frictions. Patients themselves are driven by outcomes and bedside manners. Any one disappointing member or factor will take them out of ACO. As correctly pointed out in this article; without the risks ACO will have "nothing to lose" attitude. Unless a major paradigm shift in which existing culture of individualistic physician services without sharing, is replaced by a cooperative and team working and coordinating mindsets, ACOs will not give desired savings and will fall apart like the Staff Model HMOs of the past.