New ACOs organized despite federal scrutiny

Two Arizona health systems are joining together to launch an accountable care organization (ACO) that will provide coordinated care to about 50,000 members, the organizations announced this week, in hopes of improving outcomes, patient satisfaction and cost savings.

Physicians from Banner Health Network, which includes 3,000 care providers and 15 hospitals, will manage all areas of care for members of UnitedHealthcare, which includes 78 hospitals and 14,000 physicians across the state, to improve follow-up and fill gaps in care, while monitoring all patients in a secure registry, according to the announcement. Providers will be eligible for payment incentives based on meaningful improvements in quality measures.

However, as more and more hospitals and health systems form ACOs, the Federal Trade Commission (FTC) hones in just as quickly on potentional violations of antitrust laws and guidelines. Deborah L. Feinstein, director of the FTC's Bureau of Competition, discussed some of the issues during a presentation at the Fifth National ACO Summit, in the District of Columbia last month.

"Collaboration designed to promote beneficial integrated care can benefit consumers," Feinstein said in the presentation. "On the other hand, collaboration that eliminates or reduces price competition or allows providers to gain increased bargaining leverage with payers raises significant antitrust concerns."

ACOs raise the following concerns among the FTC:

  1. Preventing payers from steering patients to certain providers

  2. Tying sales of the ACO's services to the private payer's purchase of other services from providers outside the ACO

  3. Requiring exclusivity that discourages providers from contracting with payers outside the ACO

  4. Restricting a payer's ability to make information on cost, quality, efficiency and performance available to enrollees

When considering ACO collaborations, the FTC asks the following initial questions:

  • Does the proposed arrangement offer the potential for pro-consumer cost savings or quality improvements in the provision of healthcare services?

  • Is there bona fide integration or is this simply a mechanism to enhance leverage with payers through joint negotiation?

  • Are any price or other agreements among participants regarding the terms on which they will deal with healthcare insurers reasonably necessary to achieve the benefits of the collaboration?

If the answer is yes, than the Commission assesses whether the likely effect of the collaboration will be to benefit or harm competition and consumers, according to the presentation.

To learn more:
- here's the announcement
- check out the presentation

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