Florida Medical Association

FMA Magazine - Q2 2013

Magazine of the Florida Medical Association

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An Introduction to Accountable Care Organizations (ACOs) By Jarrod Fowler Today's physician balances an extraordinary number of challenges that shape his or her practice: Overhead costs, contracts with insurers, liability insurance, decisions about whether to participate in Medicaid or Medicare programs, rapidly evolving information technology environments and, of course, providing accessible, excellent patient care. Entering the scene is a new element: The Accountable Care Organization (ACO), a payment and service delivery model that has gained traction following the passage of the federal Patient Protection and Affordable Care Act (PPACA). The advent of ACOs will present Florida's physicians with unique and varied challenges. For one, they are new and a moving target. ACOs take many shapes, and the finer details of their implementation have yet to be determined. In addition, few ACO pilots have been fully vetted or demonstrated to be effective. Furthermore, ACOs include various elements that have long caused concerned many physicians, such as pay-for-performance and increasing information technology infrastructure demands. With or without the passage of the PPACA, hospitals already have been acquiring physician practices and positioning themselves to take advantage of new public payment models. Private sector health insurers are moving in the direction of integrated delivery and payment models as well, but it is still early in the process. Florida physicians have an opportunity to shape the development of ACOs in this state, perhaps making an impact on national policy. It is critical that physicians have a leadership role within ACO governance, are able to maintain autonomy in their practices and, more importantly, in the decisions they make with their patients. The fact that ACOs will take many different forms is a challenge and an opportunity. A "one size fits all" model will not work, but this means physicians must remain alert to differences between ACOs and how to navigate our increasingly complex health care system. The concept There is growing concern that America's current health care system is heavily fragmented, does not properly align payment incentives for improving quality outcomes and has not adequately contained health care costs. ACOs are designed as an alternative to this system, wherein organized networks of providers have a common incentive to improve health outcomes for patients and reduce overall costs. ACOs may be fully integrated or loosely comprised of specific providers and facilities, and are supposed to help integrate primary care, specialty care, hospitals, labs and other services through greater care coordination. The ACO's center is the administrative organization that ties providers and facilities together and organizes performance and savings measurements. Attempts to build health care delivery systems that coordinate care are not new. Most physicians are familiar with care coordination as envisioned by managed care and, more recently, by the

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