ACOs: managed care redux?

Over at JAMA, Ezekiel Emanuel argues that ACOs are not doomed to repeat the mistakes of managed care in the 1990s. His basic argument boils down to this: we have better computers now.

He misses 2 key points:

  1. Managing is expensive. Even with great data and computers, it costs real money to translate data into cultural change. (But I agree that not managing is even more expensive)
  2. Physician control failed before.  Emanuel highlights the conflicts between health plans and docs/patients over HDC/AMBT for breast cancer, but MANY provider sponsored organizations also tried and failed at accepting financial risk in the 1990s.  Remember MedPartners? The California PSO bankruptcies? The Medicare PSO risk rules?

I’m still officially a skeptic. Prior TIE coverage of ACOs here.


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