Abstract
The U.S. healthcare system has a history of continuous organizational change. The result is by no means a perfect healthcare system. A byproduct of this history is a large number of experiments, making the U.S. probably the largest laboratory for healthcare delivery reform in the world. Both quality and costs are pressing issues for U.S. healthcare reform. Efforts to address these issues by means of integrated care delivery and innovative payment models are mostly driven by the Centers for Medicare and Medicaid Services (CMS). Many of CMS’s reform efforts can be linked to goals that are known as the Triple Aim: improving the experience of care and the health of populations while reducing per-capita costs. These aims conflict with traditional, fragmented delivery structures and fee-for-service (FFS) payments, which are still the norm for reimbursing providers. One of the most discussed alternative payment models is the accountable care organization (ACO). This chapter illustrates the concept of ACOs and discusses some preliminary findings on the impact of this mode of integrated care delivery.
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Notes
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That is, spending outside of Medicare Part C.
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The Medicare Advance Payment Model can be seen as a predecessor to this model featuring 35 participating organizations in 2015.
References
AHA. (2015). Trendwatch chartbook 2015: Trends affecting hospitals and health systems. Washington. Retrieved March 1, 2016, from http://www.aha.org/research/reports/tw/chartbook/2015/15chartbook.pdf
AHA. (2016). Fast facts on US hospitals, AHA hospital statistics 2016 edition. Retrieved February 29, 2016, from http://www.aha.org/research/rc/stat-studies/101207fastfacts.pdf
Aspen Publishers. (2015). Medicare, managed care, & other sources of revenue. In Hospital accounts receivable analysis (Vol. 29, No. 1, pp. 20–21).
Bazzoli, G. J., Dynan, L., Burns, L. R., & Yap, C. (2004). Two decades of organizational change in health care: What have we learned? Medical Care Research and Review, 61(3), 247–331.
Berenson, R. A., & Burton, R. A. (2012, January 31). Next steps for ACOs: Health Policy Brief. Health Affairs.
Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim. care, health, and cost. Health Affairs, 27(3), 759–769.
Casalino, L. P. (2014). Accountable care organizations—the risk of failure and the risks of success. The New England Journal of Medicine, 371(18), 1750–1751.
CDC. (2015). Health, United States, 2014: Trend tables, health care expenditures and payors, Table 102. Retrieved February 29, 2015, from http://www.cdc.gov/nchs/hus/contents2014.htm#102
CMS. (2015a). Accountable Care Organization 2015. Program analysis quality performance standards narrative measure specifications. Prepared by RTI International. Retrieved February 29, 2016, from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/ACO-NarrativeMeasures-Specs.pdf
CMS. (2015b). Accountable Care Organizations (ACO). Retrieved February 29, 2016, from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html?redirect=/Aco
CMS. (2015c). Medicare ACOs provide improved care while slowing cost growth in 2014. 2015 fact sheets, media release, 25 August 2015. Retrieved March 1, 2016, from https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-08-25.html
CMS. (2016). Innovation center, next generation ACO model. Retrieved February 29, 2016, from https://innovation.cms.gov/initiatives/Next-Generation-ACO-Model/
Cutler, D. M., & Scott Morton, F. (2013). Hospitals, market share, and consolidation. JAMA, 310(18), 1964–1970.
Douven, R., McGuire, T. G., & McWilliams, J. M. (2015). Avoiding unintended incentives in ACO payment models. Health Affairs, 34(1), 143–149.
Gaynor, M., & Town, R. (2012a). The impact of hospital consolidation – Update: The synthesis project. Policy Brief, No. 9.
Gaynor, M., & Town, R. J. (2012b). Competition in health care markets. In M. V. Pauly, P. P. Barros, & T. G. McGuire (Eds.), Handbook of health economics: Volume 2, Handbooks in economics (1st ed., pp. 499–637). Amsterdam/Boston: Elsevier/North Holland.
Gitterman, D. P., Weiner, B. J., Domino, M. E., Mckethan, A. N., & Enthoven, A. C. (2003). The rise and fall of a Kaiser Permanente expansion region. Milbank Quarterly, 81(4), 567–601.
HHS. (2015, January 26). Better, smarter, healthier: In historic announcement, HHS sets clear goals and timeline for shifting Medicare reimbursements from volume to value. HHS press release. Retrieved February 29, 2016, from http://www.hhs.gov/about/news/2015/01/26/better-smarter-healthier-in-historic-announcement-hhs-sets-clear-goals-and-timeline-for-shifting-medicare-reimbursements-from-volume-to-value.html
Himmler, S. & Jugl, M. (2016). Hospital costs in the U.S. and Germany. In A. Schmid & B. Fried (Eds.), Crossing borders – Health reform in the U.S., Schriften zur Gesundheitsökonomie (pp. 41–55). Bayreuth: P.C.O.-Verlag.
Introcaso, D., & Berger, G. (2015). MSSP year two: Medicare ACOs show muted success. HealthAffairsBlog. Retrieved March 1, 2016, from http://healthaffairs.org/blog/2015/09/24/mssp-year-two-medicare-acos-show-muted-success/
Jackson, G. L., Powers, B. J., Chatterjee, R., Prvu Bettger, J., Kemper, A. R., Hasselblad, V., Dolor, R. J., Irvine, R. J., Heidenfelder, B. L., Kendrick, A. S., Gray, R., & Williams, J. W. (2013). The patient-centered medical home. Annals of Internal Medicine, 158(3), 169.
Marmor, T., & Oberlander, J. (2012). From HMOs to ACOs: The quest for the Holy Grail in U.S. health policy. Journal of General Internal Medicine, 27(9), 1215–1218.
McClellan, M., Kocot, L. S., & White, R. (2015). Medicare ACOs continue to show care improvements—And more savings are possible. HealthAffairsBlog. Retrieved March 1, 2016, from http://healthaffairs.org/blog/2015/11/04/medicare-acos-continue-to-show-care-improvements-and-more-savings-are-possible/
McWilliams, J. M., Chernew, M. E., Landon, B. E., & Schwartz, A. L. (2015). Performance differences in Year 1 of pioneer accountable care organizations. The New England Journal of Medicine, 372, 1927–1936.
Muhlestein, D., Gardner, P., Merrill, T., Petersen, M., & Tu, T. (2014). A taxonomy of accountable care organizations: Different approaches to achieve the triple aim. Retrieved June 1, 2015, from http://leavittpartners.com/wp-content/uploads/2014/06/A-Taxonomy-of-Accountable-Care-Organizations.pdf
Pope, C. M. (2014). How Obamacare fuels health care market consolidation: The Heritage Foundation, Backgrounder, No. 2928. Retrieved March 1, 2016, from http://thf_media.s3.amazonaws.com/2014/pdf/BG2928.pdf
Schmid, A., & Himmler, S. (2015). Netzwerkmedizin – Impulse für Deutschland aus den USA: Stiftung Münch, Projektbericht, München.
Smith, J. C., & Medalia, C. (2015). Health insurance coverage in the United States: 2014: Current population reports, P60-253. Washington, DC: U.S. Census Bureau.
Squires, D. A. (2012). Explaining high health care spending in the United States: An international comparison of supply, utilization, prices, and quality. Issues in International Health Policy, 10, 1–14.
Wilensky, G. R. (2011). Lessons from the physician group practice demonstration—A Sobering reflection. New England Journal of Medicine, 365(18), 1659–1661.
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Schmid, A. (2017). USA: Innovative Payment and Care Delivery Models—Accountable Care Organizations. In: Amelung, V., Stein, V., Goodwin, N., Balicer, R., Nolte, E., Suter, E. (eds) Handbook Integrated Care. Springer, Cham. https://doi.org/10.1007/978-3-319-56103-5_33
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