Accountable care organizations (ACOs) — or other new types of care organizations — are probably going to keep starting up even if Congress repeals the Patient Protection and Affordable Care Act of 2010 (PPACA) or the Supreme Court vaporizes it.
Mark Jamilkowski, an actuary who is a health care consultant at KPMG Advisory, New York, gave that assessment Wednesday in an interview.
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.
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 the value of the care delivered to the cost.
CMS has announced two major ACO pilot projects, and private carriers also have been testing ACOs.
KPMG found recently when it conducted a survey of health care providers and private insurers that potential ACO participants are confused by the Medicare ACO programs and not at all sure they understand how the ACOs will really work.
Are the Medicare ACOs more confusing than the ACO pilot programs already started by the large private insurers, or all ACOs still confusing?
“I don’t think anyone’s got the answer,” Jamilkowski said.
To some extent, he said, setting up any ACO, whether public or private, is difficult, because organizers have to figure out how to get traditional enemies to team up.
Doctors have to assume more health care risk, for example, but insurers, for their part, may find they have to fund medical-office-level care management programs that are open to all people in a community, not just their own enrollees, Jamilkowski said.
Organizers of any ACO also have to get involved with complicated infrastructure and data collection and analysis projects, Jamilkowski added.
Insurers are already predicting that some providers will use the Medicare ACO programs as an excuse to ignore antitrust laws and collude to jack up prices.