Accountable Care Organizations or Accountable Scare Organizations?

December 3, 2010 · Leave a comment

Industry Insights from Paul Meade, M.Sc., MPH

There has been a lot of talk lately of a new form of healthcare delivery known as “accountable care organizations” (ACOs). And while it may seem as yet another type of managed care organization, these ACOs are attempting to introduce the element of quality balanced with fiscal responsibility and cost containment. Undoubtedly, this is a noble attempt at bringing quality healthcare at an affordable level to patients within the United States. Actually, who could argue with affordable, quality healthcare based on sound outcomes research and cost-benefit analysis? So where is the scare?

Could the concept of an ACO be a variation on the theme of capitation that we saw in the 80s? The basic principle is for healthcare providers to deliver the optimal healthcare within a specified budget. So what’s the difference? Well, the old capitation model was based on responsible economic principles; deliver the best healthcare you can with the money you’ve got. The problem was that in order to meet the capitation hurdles, many providers simply under-delivered services, so a short-term gain often resulted in a long-term loss. Also, quality initiatives and health outcomes research was still in its infancy, so finding the optimal healthcare solution was often a hit-or-miss situation. But today, there are better quality measures based on outcomes research ... read more »

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