Analysis & commentary: Accountable care organizations: The case for flexible partnerships between health plans and providers

Health Affairs

Volumn 30, Issue 1, 2011, Pages 32-40

  Goldsmith, Jeff ^a  

^a UNIVERSITY OF VIRGINIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ACCOUNTABLE CARE ORGANIZATION; ARTICLE; EMERGENCY HEALTH SERVICE; FINANCIAL MANAGEMENT; HEALTH CARE; HEALTH CARE COST; HEALTH CARE ORGANIZATION; HEALTH CARE PERSONNEL; HEALTH CARE PLANNING; HEALTH CARE POLICY; HEALTH CARE SYSTEM; HEALTH PROGRAM; HEALTH SERVICE; HOME CARE; HOSPITAL BILLING; HOSPITAL CARE; HOSPITAL PHYSICIAN; HOSPITALIZATION; HUMAN; INTERVENTION STUDY; MARKETING; MEDICAL CARE; MEDICAL PRACTICE; MEDICARE; OUTPATIENT CARE; PRIMARY MEDICAL CARE; PRIVATE HEALTH INSURANCE; SPECIALTY CARE; COST CONTROL; ECONOMICS; GOVERNMENT; HEALTH CARE DELIVERY; HEALTH ECONOMICS; HEALTH INSURANCE; LEGAL ASPECT; METHODOLOGY; ORGANIZATION; ORGANIZATION AND MANAGEMENT; PATIENT CARE; PUBLIC-PRIVATE PARTNERSHIP; REIMBURSEMENT; STANDARD; UNITED STATES;

CENTERS FOR MEDICARE AND MEDICAID SERVICES (U.S.); COST SAVINGS; DELIVERY OF HEALTH CARE; ECONOMICS, HOSPITAL; HUMANS; INSURANCE, HEALTH; ORGANIZATIONAL INNOVATION; PATIENT PROTECTION AND AFFORDABLE CARE ACT; PATIENT-CENTERED CARE; PUBLIC-PRIVATE SECTOR PARTNERSHIPS; REIMBURSEMENT, INCENTIVE; UNITED STATES;

EID: 79951664941     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2010.0782     Document Type: Article

References (20)

1. Pratt MK. Humana Inc.: keeping a watchful eye on patients. Computerworld. 2006 Sep 18.
2. Fisher ES, Staiger DO, Bynum JPW, Gottleib DJ. Creating accountable care organizations: the extended hospital medical staff. Health Aff (Millwood). 2007;26(1):w44-57. DOI: 10.1377/hlthaff.26.1.w44.
3. Fisher ES, McClellan MB, Bertko J, Leiberman SM, Lee JJ, Lewis JL, et al. Fostering accountable health care: moving forward in Medicare. Health Aff (Millwood). 2009;28(2):219-31.
4. Harris G. More doctors giving up private practices. New York Times. 2010 Mar 26.
5. Medical Group Management Association. Physician placement starting salary survey: 2010 report based on 2009 data. Englewood (CO): MGMA; 2010 Jun 4.
6. Dranove D. Viewing health care consolidation through the lens of the economics of strategy [Internet]. Princeton (NJ): Robert Wood Johnson Foundation; 2010 Mar [cited 2010 Dec 6]. Available from: http://www. academyhealth.org/files/publications/HCFOReportMarch2010.pdf
7. Berenson RA, Ginsburg PB, Kemper N. Unchecked provider clout in California foreshadows challenges to health reform. Health Aff (Millwood). 2010;29(4):699-705.
8. According to a study funded by the Robert Wood Johnson Foundation, 88 percent of US metropolitan area residents already lived in "highly concentrated" hospital markets by 2003, thanks to a 1990s wave of hospital merger activity. Hospitals' acquisition of physician practices would further consolidate those markets by enabling hospitals to control contracting for physician services. Vogt WB, Town R. How has hospital consolidation affected the price and quality of hospital services. Princeton (NJ): Robert Wood Johnson Foundation; 2006. Research Synthesis Report No.: 9.
9. Goldsmith J. Hospitals and physicians: not a pretty picture. Health Aff (Millwood). 2007;26(1):w72-5. DOI: 10.1377/hlthaff.26.1.w72.
10. Burns LR, Pauly MV. Integrated delivery networks: a detour on the road to integrated health care? Health Aff (Millwood). 2002;21(4):128-43.
11. Hogan SO, Kissam SM. Measuring meaningful use. Health Aff (Millwood). 2010;29(4):601-6.
12. American College of Physicians. The impending collapse of primary care medicine and its implications for the state of the nation's health care: a report from the American College of Physicians [Internet]. Philadelphia (PA): ACP; 2006 Jan 30 [cited 2010 Jul 12]. Available from: http:// www.acponline.org/advocacy/events/state-of-healthcare/statehc06-1.pdf
13. Kilo CM, Wasson JH. Practice redesign and the patient-centered medical home: history, promises, and challenges. Health Aff (Millwood). 2010;29(5):773-8.
14. Fields D, Leshen E, Patel K. Driving quality gains and cost savings through adoption of medical homes. Health Aff (Millwood). 2010;29(5):819-26.
15. In most medical home demonstrations, a blended payment approach is employed, including a monthly per capita "care coordination" payment, regular fees for patient visits, and a performance-based bonus contingent on achieving certain quality and efficiency measures. This approach imposes additional administrative costs on the practice beyond those required to support a more comprehensive care model. Merrell K, Berenson RA. Structuring payment for medical homes. Health Aff (Millwood). 2010;29(5):852-8.
16. Alakeson V, Frank RG, Katz RE. Specialty care medical homes for people with severe, persistent mental disorders. Health Aff (Millwood). 2010;29(5):867-73.
17. Berenson RA, Hammons T, Gans DN, Zuckerman S, Merrell K, Underwood WS, et al. A house is not a home: keeping patients at the center of practice redesign. Health Aff (Millwood). 2008;27(5):1219-30.
18. A sophisticated precursor of this model, the Prometheus Payment Model, used a similar approach, paying a fixed fee per episode of care but including bonuses based on shadow capitation. DeBrantes F, Rosenthal MB, Painter M. Building a bridge from fragmentation to accountability: the Prometheus Payment Model. N Engl J Med. 2009; 361(11):1033-6.
19. Steele JR, Reilly JD. Bundled payments: bundled risk or bundled reward? J Am College Radiol. 2010;7(1):43-9.
20. Wynn ME. Modernizing the Medicare program using global payment policies. Manag Care Q. 2001;9(3):42-51.