ACOs: Many questions, few answers

The 2010 AcademyHealth Annual Research Meeting has concluded. Over the coming weeks to months I’ll post on some things I learned, starting with this post. (I also hope to include in future posts some very nice figures I saw in talks and on posters, assuming I can get my hands (er, mouse) on them.)

My main questions about health reform at the moment are: (1) What form will accountable care organizations (ACOs) take? And (2) how will the market power effects of provider integration ACOs may encourage be handled on the private side?

This will be a short post because the answers to those two questions are both, “Nobody knows.” A new office at CMS will be formed next year to test and roll out ACO-related ideas. There are a lot of them and no clear winner. That’s not a bad thing. Running demos and pilots to evaluate the effects of different models is exactly the right thing to do at this stage.

Many economists and health policy experts at the conference expressed concern over provider market power (mostly hospitals), which is generally seen as the source of health care cost growth. But what’s to be done about it? Some ACO models might exacerbate it. That isn’t a problem for Medicare or Medicaid since they can set prices. But it is a problem for private insurers and those of us who buy their products.

Antitrust enforcement isn’t necessarily a complete solution if it solves the private-side problem only by undoing a public-side solution.

As I learn and think of ideas I’ll post them.

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