Health Care Thoughts: Defining An ACO

Having recently plowed through about hundreds of pages on Accountable Care organisations (ACOs) and Integrated Delivery Systems (IDSs), I should know how to define an ACO.

But I don’t know, not exactly. Using an old Supreme Court standard, I know one when I see it, I think, because of certain characteristics.

This is critical because the Obama administration expects to garner huge savings from providers working through ACOs, beginning for Medicare in 2012 (building such systems in less than 9 months is going to be a Herculean task)..

The best formal definition I have seen to date, and it is very general, is the CMS definition for Medicare ACOs, and I quote:

Q: What is an “accountable care organisation.” A: An Accountable Care organisation, also called an “ACO” for short, is an organisation of health care providers that agrees to be accountable for the quality, cost and overall care of [Medicare] beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it (ACO).

It is a start, barely. The ACOs are supposed to be in place 1/1/2012. Administrative regulations were issued in November 2010 and the public comment period ended recently.

In a recent speech DHHS Sec. Berwick offered these “flag and apple pie” characteristics, still very general:

  • the patient and family will be at the centre;
  • teamwork will now become “paramount;”
  • respect resources and reduce waste;
  • reinvest where investment counts;
  • measure and manage outcomes partially through electronic health records; and
  • establish a solid health care workforce foundation

Tom aka Rusty Rustbelt

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