An HMO by any other name, except Medicare beneficiaries won’t have a choice-Accountable Care Organizations and Community Health Teams

Coordinated, managed care is a good thing and something that is sorely lacking. 

However, the government should tell people the truth about  Accountable Care Organizations (ACO)  and Community Health Teams rather than burying the ACO in the PPACA  or just alluding to the health teams in a Joe Biden e-mail. The goal of PPACA is to greatly change not only the way health care is paid for, but how it is delivered.  This effort is not new, the concept of the pure HMO was tried forty years ago (HMOs for the most part are no longer true coordinated care organizations).  I say tried because the goal of managing care through coordination among physicians in a somewhat closed environment was roundly rejected by both physicians and Americans.  That is not to say the concept is bad, in fact the opposite is true. 

The questions are how much do we want the federal government in this process and is there any reason to believe that these new experiments will work any better than past attempts?  One could argue that we are in a different environment, that costs really matter and yet back in the 1980s health care inflation was higher than it is today. The one factor that has not changed is people and their perception of health care and how it should be provided.  During the health reform debate politicians were very careful to avoid the “R” word – rationing, but the truth be told there is no way to control health care costs other than with some form of rationing.  Managing health care, coordinating care is a form of rationing, most likely good rationing, but rationing nevertheless.    The real trick is to change the way health care is perceived by both patients and physicians. Is government control the best way to do that?  There is one other key factor in all this that is rarely mentioned, if we are successful in our desire to change health care in America physician income is likely to decline. Should we discuss the consequences of that happening?

From Bloomberg Newsweek:

In the meantime, doctors are being driven together in practice by health reform and “solo practices could be on the way out,” National Journal reports. “The health care reform law created pilot programs within Medicare to test [accountable care organization] models, with the expectation that they will begin to revolutionize the way that all doctors and hospitals deliver medical care. Better coordination between medical providers, the theory goes, should result in higher-quality care and lower costs. Beginning in 2012, the participating organizations, which will include doctors and hospitals, will be responsible for the overall care of the Medicare beneficiaries they serve. If an ACO measures up, its medical providers will share in the savings.”

Doctors are increasingly looking to band together in ACOs to reduce costs and put themselves in line for the Medicare money such organizations are likely to see after health reform is implemented. “The big question now is not whether accountable care organizations are the future, but who will control that future” (Werber Serafini, 6/26

More on Accountable Care Organizations here and here.