One part of the Patient Protection and Affordable Care Act that’s hit American health care like the British Invasion is accountable care organizations, or ACOs. At first, there were just a few, then some more and now they’re all over the place, just as The Beatles, The Rolling Stones, the Who, the Kinks and other groups took over American pop culture in the 1960s.
In an ACO, doctors, hospitals, Medicare, providers and patients come together like John, Paul, George and Ringo to coordinate health care with the idea of improving quality and reducing costs. When PPACA was passed, ACOs were touted as a way to lower health care expenditures under Medicare and encourage collaborative care among providers.
“These innovative programs are showing encouraging initial results, while providing valuable lessons as we strive to improve our nation’s health care delivery system,” said Kathleen Sebelius, Health and Human Services Secretary at the time. “Organizations of various sizes and structures across the country are working with their physicians and engaging with patients to better coordinate and deliver high-quality care while reducing expenditure growth.”
More and more health care providers are joining ACOs, too. Regional and local hospitals, physician groups, independent physicians associations and nonprofits are well represented in ACO agreements across the country. Some very large players in the health care began exploring ACOs before PPACA, such as Aetna, and others have gotten into the game as well, including Blue Cross and Anthem.
ACO skeptics have been quick to point out the similarities of the model to health maintenance organizations, or HMOs. There’s one key difference, though: Patients aren’t required to stay within a network to get health care.
Read: HMOs vs. ACOs
“These results not only quantify cost reductions but they also speak to improvements in quality and care coordination, such as reductions in avoidable hospitalizations and readmissions,” Thomas says. “Banner was able to reduce costs for individuals and employers as well through Aetna Whole Health, a health plan product it launched with Aetna based on the ACO network. The product utilizes plan designs that allow individuals and employers to take full advantage of the results listed above. In addition, the products can be priced anywhere from 8–15 percent below prevailing market rates because they take advantage of a more efficient and quality-focused care model.”
For brokers and agents