Republican and Democratic lawmakers have applauded Premier Healthcare Alliance's launch of two new accountable care organization (ACO) efforts covering 1.2 million patients in almost 60 hospitals, The Hill reports. Not only did Senate Finance Chairman Max Baucus (D-Mont.) and Reps. Earl Pomeroy (D-N.D.) and Charles Boustany (R-La.) on Thursday cheer the initiative's promise to reward quality over quantity, but vowed to ensure Congress would address the antitrust and other problems that may arise from the hospital-doctor collaborations.
ACOs are defined as a group of healthcare providers coming together to accept accountability for a defined patient population's care, according to a Premier press release. As part of this year's health reform legislation, ACOs are designed to keep patients healthy and out of intensive care settings, while simultaneously incentivizing improved patient outcomes and cost effectiveness.
But the idea faces steep legal and cultural challenges. Despite the appeal of breaking the traditional "silos" in medicine, many doctors who are independent by nature may not want to be employees of a big hospital group. In addition, it's still unclear how pay-for-patient care would be divided, and how to handle state and federal antitrust and anti-kickback laws.
Although all three lawmakers acknowledged there was still work to be done on the health system, Pomeroy, a former insurance commissioner, indicated that, at least with ACOs, the kinks could be worked out. "Without question, the congressional intent is very clear in the bill: We want greater collaboration and reimbursement innovations along the lines of Accountable Care Organizations. If that can't be achieved in the anti-trust context, then we need to ensure that it can be. I think you could argue that the bill already takes care of that problem."
And before it became part of the national legislation, Vermont put together a strategy to launch three community-based ACOs by 2012, reports HealthLeaders Media. The ultimate goal of one of the three resulting pilots, the"Vermont ACO Pilot," is to "achieve delivery system reform based on the development of a true community health system that both improves the health of the population it serves and manages medical costs at a population level," reports The Commonwealth Fund.
All three pilots center around three major principles--local accountability, payment reform and performance measurement. The experimental state also identified five threshold capabilities an ACO must have to be viable, including the ability to manage the full continuum of care settings and services for its assigned patients, full financial integration with payers and the technological capability to connect all ACO providers.