While the unfixed sustainable growth rate formula and other uncertainties are keeping many practices back from participating in accountable care organizations (ACO), 49 percent of primary care physicians and 53 percent of endocrinologists are expected to adopt the model within the next year, according to a new report from the U.S. Physician and Payer Forum.
In addition, the survey found that most physicians already participating in ACOs contract with commercial plans, as well as Medicare Advantage and Medicaid MCOs, "highlighting how rapidly this program is expanding across the industry," according to a statement.
The PCPs and endocrinologists involved in ACOs are incentivized to lower costs through hospitalization rates, as well as prescribing more generic medications. As a result, surveyed pharmacy benefit directors ranked congestive heart failure and type II diabetes, for which many low-cost generics exist, as two of the top conditions to yield clinical benefits and cost savings.
Not all experts are convinced that ACOs will deliver on such promises, however, according to a recent Health Affairs commentary suggesting that ACOs have too much in common with the failed integrated delivery networks of the 1990s to succeed, Kaiser Health News reported.
Although organizations have better technology and infrastructure in place this time around, in addition to lower risk of profit loss by hiring more individual physicians, authors Lawton R. Burns and Mark V. Pauly of the University of Pennsylvania's Wharton School wrote that these advantages may not be enough to overcome today's challenges.
"Care coordination and information technology are proving more complicated and expensive to implement than anticipated, providers may lack the ability to implement these mechanisms, and primary care providers are in short supply.
To learn more:
- read the post from Kaiser Health News
- see the abstract from Health Affairs
- see the statement and report from Decision Resources