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Adam has prompted a lot of exchange about ACOs The question of how to think about notions like ACOs seems to me more fundamental than one or another technical feature associated with the legislation and the regulations. And, to that question, ACO expressions are like integrated delivery systems IDS, HMOs, and Managed Care--all of which are persuasive definitions. That is, by definition, the term suggests worthy performance> Nobody is in favor of the antonym: disintegrated delivery systems, health plans that make people sicker, unmanaged care. And, in that respect, they reflect the impact of marketing modes, associating organizational forms with benevolent images quite apart from evidence about how organizations actually work. What is so striking to me is the expansion of this category in recent decades. Before and up to the 1960s, critics of classic, NHI reforms used moralistic categories like "socialized medicine" and 'big government" to warn about policy change. Now reformers use misleading marketing terms to describe what is wished to be the case, not shown to be. Or so it seems to me. Cheers, Ted -----Original Message----- From: Anglo-American Health Policy Network [mailto:[log in to unmask]] On Behalf Of Uwe E. Reinhardt Sent: Monday, January 12, 2015 2:53 PM To: [log in to unmask] Subject: Re: HMOs and ACOs 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? Please access the attached hyperlink for an important electronic communications disclaimer: https://urldefense.proofpoint.com/v2/url?u=http-3A__lse.ac.uk_emailDisclaimer&d=AwIFAg&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=ayydcxnWxiVAdTcBaHwKkpJpaUzZhWdpggcIiNfVcRQ&m=PxsPQbtZC-3ea7yVjLoi8Vnv8aoQoicjv-1Ys7ngEcI&s=1LD9xwuc0UcHzy_fdkCJa3BaMOR3UeGnT3rvLBxbhoM&e= Please access the attached hyperlink for an important electronic communications disclaimer: https://urldefense.proofpoint.com/v2/url?u=http-3A__lse.ac.uk_emailDisclaimer&d=AwIFAg&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=ayydcxnWxiVAdTcBaHwKkpJpaUzZhWdpggcIiNfVcRQ&m=PxsPQbtZC-3ea7yVjLoi8Vnv8aoQoicjv-1Ys7ngEcI&s=1LD9xwuc0UcHzy_fdkCJa3BaMOR3UeGnT3rvLBxbhoM&e=