Many U.S. physicians still have no idea what an accountable care organization (ACO) really is.
Kunal Pandya, an analyst at Aite Group L.L.C., Boston, makes that observation in a new report on the ACO effort.
An ACO is supposed to be a vehicle for paying teams of health care providers to provide and manage care for whole patients, instead of paying for care one service at a time.
The Patient Protection and Affordable Care Act of 2010 (PPACA) requires the Centers for Medicare & Medicaid Services (CMS) to try using ACOs and other new approaches to paying doctors and hospitals to get providers to work harder at paying attention to the cost of care, and the ratio of value to cost.
CMS has announced two major ACO pilot projects, and private carriers also have been testing ACOs. Providers have been slow to sign up for the projects, in part because awareness levels in the provider community, and providers have no understanding of the ways they could benefit from participating, Pandya says.
AN APPLES-TO-SMALLER-APPLES COMPARISON
Just as food manufacturers are trying to hold apparent food prices down by reducing the amount of food in a typical package, health insurers and employer plan sponsors are trying to hold plan prices down by reducing the amount of care each plan covers.
Health coverage “benefit buydowns” should cut commercial health plan premium rate increases to 5.5% in 2012, from 8% without buydowns, according to Sherlock Company, Gwynedd, Pa.
For 2011, the average expected increase was 10% without buydowns and 7% with buydowns, Sherlock says.
Sherlock has based those estimates on a survey of 73 plans that cover about 30 million commercial plan enrollees.
The medical trend, or increase in underlying health care costs, could be 8.8% in 2012. A year ago, carriers were predicting the medical trend for 2011 would be about 11%.
AMA: PROTECT OUR MEMBERS’ WALLETS
The American Medical Association (AMA), Chicago, says it will be advertising on radio and television to mobilize consumers and doctors to act against a looming change in the Medicare physician payment formula.