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PPACA: Expert Sees Keen Interest in ACO Concept

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U.S. health insurers are following accountable care organization (ACO) regulatory efforts closely, an Affordable Care Act watcher says.

“At a very high level, they’re interested in this,” says Maureen Fahey, a principal at KPMG, New York, who is leading the firm’s efforts to track implementation of Affordable Care Act — the legislative package that includes the Patient Protection and Affordable Care Act (PPACA) – and related laws and regulations.

“I am positive about the actions the insurers are taking to understand the reform act and tPPACAo determine their best strategic positions,” Fahey says.

The ACO is a vehicle for paying teams of health care providers to care for whole patients, instead of paying for care one service at a time.

In the past, the federal government tried to hold down rising health care costs by imposing strict limits on health care providers’ financial relationships with other providers.

The Affordable Care Act includes provisions that require the Centers for Medicare and Medicaid Services (CMS) to work with ACOs and give federal agencies the authority to keep antitrust laws, anti-kickback laws, and similar laws from interfering with ACO operations.

“I think there’re still a lot of unknowns about those (ACO) structures and how they’ll work,” Fahey says.

The U.S. Department of Health and Human Services (HHS) is still developing the ACO regulations, Fahey says.

But Fahey says she believes the kinds of ACO structures now under consideration would encourage healthy competition.

Current thinking seems to be that ACOs’ structures may vary significantly based on geography, demographics and other factors, Fahey adds.


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