Over the past decade, I’ve seen a number of studies asking people whom they trust among various health care stakeholders. Nurses, pharmacists, and doctors always come out at the top. Beyond that:
- Trust of hospitals tends to be high (60–80%)
- Trust of health plans is at the bottom of the heap (10–20%)
Is this written in stone for the future? I don’t think so…and the dynamics for change are in motion. Please read on.
Here’s the emerging picture I’m seeing:
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One of the biggest concerns about ACOs has been their potential to enable market consolidation— that by uniting health care providers the ACO gains market clout and ability to charge higher prices.
While this is a legitimate concern about ACOs, so far it’s not playing out.
Why?
Continue reading “The ACO Antitrust Police — Nothing to Do”
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ACO,
antitrust
I’m surprised and intrigued by Medicare’s announcement of 27 new Shared Savings model ACOs.
Surprised
I had been anticipating this announcement as a defining moment for Medicare’s thrust into accountable care. My expectations had been that we would see either:
Boom — a big splash of new Medicare shared savings ACOs announced, including big name hospitals and medical groups that were starting large scale ACOs, perhaps with hundreds of thousands of patients.
Bust — no one showed up at the party. Providers would have concluded that Medicare ACOs were too risky, bureaucratic, and high effort.
Intrigued
What we got is something in the middle: Continue reading “Medicare Announces 27 ACOs. A New Species?”
Tags:
accountable care,
ACO,
Medicare
On the Perficient Health IT blog, Christel Kellogg writes:
I am hearing that carriers are staying away from ACOs and are not planning on partnering. What have you heard?
This is one of those blip-on-the-radar-screen comments that jarred my attention — and it raises very important questions about industry dynamics.
First, let me expand on the issue. As I’ve written before, there are at least two broad categories of “accountable care initiatives”:
1) Formal Accountable Care Organizations (ACOs) by which care providers contract with Medicare
2) Informal Accountable Care-Like (AC-Like) arrangements between care providers and commercial health plans.
The list of accountable care animals in the forest is likely to keep growing. For example, just this week Oregon announced details for CCOs (Coordinated Care Organizations) for Medicaid.
So how are different stakeholders likely to react to the opportunity of a formal ACO contracting with commercial health plans? Let’s look at this from a couple of different angles.
Continue reading “Will Health Plans Want to Contract with ACOs? Maybe, Maybe Not.”
Tags:
accountable care,
ACO
Last week I wrote about five key differences between formal ACOs (mainly care providers contracting with Medicare) and informal Accountable Care-Like (AC-Like) arrangements between care providers and commercial health plans.
- Transaction costs
- Timing
- Incrementalism
- Flexibility
- Capital cost
There’s an important 6th difference worth noting:
Visibility
Formal ACOs will be visible from miles away — think elephants on the Serengeti.
An ACO that wants to contract with Medicare must establish itself as a corporation. The Medicare ACO models have substantial disclosure and reporting requirements. We won’t know everything about formal ACOs, but we will know a lot. ACOs cannot hide.
AC-Like arrangements between care providers and commercial payers could be much more difficult to spot and categorize — think chameleons in the jungle.
Continue reading “A 6th Difference Between ACOs and “AC-Like” Arrangements”
Tags:
ACO
Head on over to Boston Health News to read the latest in health wonkery! Tinker Ready greets us with the St. Patrick’s Day Edition of the latest and best coming from the health care blogosphere.
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Blog Carnivals
Let’s look at the U.S. smartphone operating system (OS) market as an example.
In 2007, Apple iOS and (Google) Android had a collective market share of 0%.
Today they have a collective market share of 77%.
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A lot. AC-Like arrangements will be MUCH simpler to create and maintain.
The health care market is moving toward accountable care. There are at least two broad paths forward:
1) Formal Accountable Care Organizations (ACOs) by which care providers contract with Medicare
2) Informal Accountable Care-Like (AC-Like) arrangements between care providers and commercial health plans
What are the differences between these routes? I see at least 5 factors at play:
- Transaction costs
- Timing
- Incrementalism
- Flexibility
- Capital cost
Continue reading “What’s the Difference Between ACOs and “AC-Like” Arrangements?”
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Competition today in healthcare encourages care providers to hoard patient data.
That’s inefficient, ineffective, and just plain wrong.
But we’re seeing light at the end of the tunnel — the proposed Stage 2 Meaningful Use (MU) rules reinforce new, evolving accountable care payment approaches. The rules support moving competition in healthcare to the right bases — sharing and adding value to patient health record data.
Today: Competition Based on Hoarding Patient Data
Health care providers today have incentive to hoard patient health record information. They might phrase it as:
I don’t get paid to share data with other doctors and hospitals — I get paid to do procedures, tests, surgeries, admissions….
HIPAA has severe penalties for sharing data inappropriately. I could spend time in jail for violating privacy/security regs for sharing patient data when I shouldn’t. Better to be safe than sorry.
Why would I want to share data with other doctors or hospitals? They are competitors. Patient data is MY competitive asset. Would I like to have access to their data? Of course…but no way will I share my data.
Would I want to provide other care providers with information to help keep a patient shared care plan current? What’s a shared care plan?
Competition Based on Hoarding: Wrong!
Continue reading “Stage 2 MU Rules: Shifting Competition from Hoarding to Sharing”
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