Something may be new, because IT has progressed so fast that now things may be possible that were not feasible in the 1990s. But the general ideas driving these concepts have always been the same as is the criterion that drives the acept or reject decision: money.
-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]]
Sent: Monday, January 12, 2015 2:49 PM
To: Uwe E. Reinhardt
Cc: [log in to unmask]
Subject: Re: HMOs and ACOs
So, there's absolutely nothing new about ACOs?
Sent from my iPhone
On 12 Jan 2015, at 18:51, Uwe E. Reinhardt <[log in to unmask]<mailto:[log in to unmask]>> wrote:
As I understand it, there are
1. staff model HMOs that actualy employe salaried physicians and may or may not own hospitals
1. HMOs that own their own hositals but contract with a separate group of physicians, and the latter are salaried employees of that group. The Kaiser Permanent system follows that model. Kaiser physicians are emplyees of the independent Kaiser Permanent Physician Group with contracts exclusiveley with Kaiser, the insurance company, which also owns its own hospitals
1. "Virtual HMOs," in which an indepentent-practice association (IPA) of self-employed physicians band together to take capitation, either only for all physician services and perhaps prescription drugs, or for hosital care as well. They come in all shades. One offshoot of this arrangement are PHOs, "phyisician-hospital organizations."
The term ACO is a more general term that can manifest itself in all of these forms and had fifferent names earlier on. Kaiser Permanente is the poster boy for an ACO. But ACOs can also be just a lose contractual arrangements among physicians, hospitals and pharmacies. It is a bit like using "animal" to describe a poodle. All poodles are animals (ok, I agree, I know of one poodle who is human), but not all animals are poodles. ACOs are animals. They are part of the current American Dream which, as you know, is dynamic.
Tomorrow it will not be ACOs, but VVTM and the year after VV+ChoiceTM, where "VV" stands for "Value Valuing." I have formally registered that concept, because I think in America it has potential. But I have not thought ahead as far as three years from now. Any ideas, folks on this circuit? What new management concept might capture our imagination and populate the conference circuit in America?
Happy New Year!
________________________________
From: Anglo-American Health Policy Network [mailto:[log in to unmask]<mailto:[log in to unmask]>] On Behalf Of Shirley Johnson-lans
Sent: Monday, January 12, 2015 1:28 PM
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: HMOs and ACOs
Hi Adam,
As I understand it, a staff type HMO, i.e. one that owns hospitals and labs and pays physicians on a salaried or capitation basis (such as Kaiser Permanente) can apply to become an ACO under the provisions of the Affordable Care Act, in which case it may be rewarded for cost-efficiency and good patient outcomes. So the two are not mutually exclusive. And some integrated IPAs (Independent Practice Associations) may also be ACOs without being HMOs. In that case the organization may not require a gatekeeper referral for specialist services. So, in that case an ACO might be thought to be less restrictive than an HMO.
Hope this helpful,
Shirley
On Mon, Jan 12, 2015 at 12:53 PM, Adam Oliver <[log in to unmask]<mailto:[log in to unmask]>> wrote:
Are there fundamental differences between HMOs and ACOs, other than HMOs being a bit more restrictive?
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