The federal health care reform act attempts to improve the health care delivery system through a variety of incentives. One of these encourages the creation of Accountable Care Organizations (ACOs). But what is an ACO? Basically, it is an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of patients. At this point, ACOs are just a concept as federal regulators have not yet established the rules for their operation. But as contemplated by the reform act, ACOs would be integrated delivery systems involving doctors, hospitals, and other providers whose reimbursement would be based partly on meeting certain quality and cost measures. Medicare will start using the ACO concept in 2012. Providers are also currently developing ACOs for the private insurance market.
As providers begin to establish these new entities, some questions and concerns have arisen. The most significant is the possibility that providers’ new networks could run afoul of current antitrust and anti-fraud laws in terms of restricting competition or fixing prices. Insurers, on the other hand voice concerns that providers could use the leverage of ACOs to demand higher prices.
For more information see:
Health Care Providers, Insurers: Accountable Care Organizations Bring Legal Worries
JAMA Commentary Reviews Accountable Care Organizations
ACOs: A Quick Primer
Creating Accountable Care Organizations
