Can ACOs survive a repeal and replacement of the Affordable Care Act?

Just as the fate of the Affordable Care Act is up in the air, so is the future of accountable care organizations, which were established under the healthcare reform law to improve care and reduce costs.

But one leading health policy expert predicted that even if Republican lawmakers come up with a plan to repeal and replace the healthcare reform law, ACOs will survive. They will just need to adapt to the new regulatory landscape.

“ACOs are here to stay,” wrote Paul Keckley, Ph.D., managing editor of The Keckley Report, in a post for Hospitals & Health Networks. “How they fit into a medical group or health system’s contracting and population health strategies will change as regulations like MACRA kick in and as employers, insurers, Medicare and Medicaid assess their value.”

More than 850 ACOs currently provide care to more than 28 million patients across the country. This year 570 ACOs will participate in Centers for Medicare & Medicaid Services models, including the Shared Savings Program  (MSSP), Next Generation ACO Model and The Comprehensive ESRD Care Model.

Two recent studies showed evidence that ACOs do lead to quality improvements and cost reductions, but those benefits grow over time. The problem is that Tom Price, the new head of the Department of Health & Human Services, doesn’t support some value-based care initiatives, such as Medicare’s mandatory bundled payment initiatives for hip and knee replacements.

But Keckley predicted physician-led ACOs that follow practices to standardize care and incentives for clinicians linked to cost savings will survive. However, in order to survive the organizations must focus on primary care driven care coordination, he said. “From these primary care centric models, virtual ACOs that incorporate rural health and teleconnectivity, and clinical models that include social determinants of health in assessing risks and care coordination tactics will evolve,” he wrote.

He also predicted that CMS will change quality measures and simplify reporting requirements under MSSP ACOs. And if Congress does move to Medicaid block grants, he expects Medicaid ACOs will be a growth opportunity.