David Cutler et. al. makes some very important points in this article regarding the need to create competition and not allow the ACO to become a completely hospital dominated phenomenon.
On this blog in the last year we have made similar points including that the ACO should be focused more on delivering better value to patients by considering the entire patient condition and including the cost and quality outcome measures related to the condition vs. simply creating a new structure that can't deliver anything in the way of improved value. Part of this challenge is to be able to actually measure value. Since value metrics don't exist yet, how will we know if one ACO is performing better than another?
I will be at the IOM's Value Incentives meeting this week. ThedaCare has just completed a full review of the penalties Medicare applies to it's collaborative Care Unit for delivering higher quality lower cost care. That paper will be included in the Value Incentives materials sent to all participants. It will also be the subject of a follow-up blog this week which will include the paper.
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