Accountable Care Organizations and Community Empowerment - — JAMA

Commentary
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JAMA. Published online April 19, 2011. doi: 10.1001/jama.2011.547 Accountable Care Organizations and Community Empowerment
Benjamin F. Springgate, MD, MPH; Robert H. Brook, MD, ScD

[+] Author Affiliations

Author Affiliations: RAND Corporation, Santa Monica, California (Drs Springgate and Brook); and Tulane University School of Medicine, New Orleans, Louisiana (Dr Springgate).

Corresponding Author: Benjamin F. Springgate MD, MPH, RAND Corporation, 1776 Main St, Santa Monica, CA 90401 (bspringg@rand.org).

KEYWORDS: ACCOUNTABLE CARE ORGANIZATIONS, COMMUNITY HEALTH SERVICES, COSTS AND COST ANALYSIS, DECISION MAKING, ECONOMICS, MEDICAL, HEALTH CARE SYSTEM REFORM, HEALTH POLICY, MEDICARE, PATIENTS.

Implementation of the Affordable Care Act and health care reform is under way. A central dimension of this process that has captured health sector interest is development and implementation of accountable care organizations (ACOs). ACOs are formal collaborations of health care professionals who agree to assume responsibility for providing a specific and potentially comprehensive set of health care services to a defined population of at least 5000 Medicare recipients. ACOs are considered to have the potential to reconfigure care-delivery systems to align incentives among physicians, other health professionals, hospitals, and payers (primarily the federal government through Medicare and the federal share of Medicaid) with the goal of increasing perceived value of care, improving clinical outcomes, and lowering health care costs (the triple aim).1​ The Centers for Medicare & Medicaid Services has indicated that the secretary of the Department of Health and Human Services will share some portion of savings derived from lower costs of ACO care with ACO clinicians.2

Less apparent to the public during this period of historic change are the struggles occurring in US board rooms among hospital groups, specialty physicians, and primary care clinicians—debating quietly but intensely over how to form these ACOs, how to be accountable for care delivery, and how to divide anticipated savings derived from ACOs. However, in most of these settings, important constituencies—middle class and other working patients whose health and welfare are at stake—are not included in the discussions.

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Accountable Care Organizations and Community Empowerment - — JAMA