JiscMail Logo
Email discussion lists for the UK Education and Research communities

Help for AAHPN Archives


AAHPN Archives

AAHPN Archives


AAHPN@JISCMAIL.AC.UK


View:

Message:

[

First

|

Previous

|

Next

|

Last

]

By Topic:

[

First

|

Previous

|

Next

|

Last

]

By Author:

[

First

|

Previous

|

Next

|

Last

]

Font:

Proportional Font

LISTSERV Archives

LISTSERV Archives

AAHPN Home

AAHPN Home

AAHPN  January 2015

AAHPN January 2015

Options

Subscribe or Unsubscribe

Subscribe or Unsubscribe

Log In

Log In

Get Password

Get Password

Subject:

Re: HMOs and ACOs

From:

"Marmor, Ted" <[log in to unmask]>

Reply-To:

Marmor, Ted

Date:

Tue, 13 Jan 2015 17:37:45 +0000

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (68 lines)

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= 

Top of Message | Previous Page | Permalink

JiscMail Tools


RSS Feeds and Sharing


Advanced Options


Archives

March 2024
February 2024
January 2024
December 2023
November 2023
October 2023
September 2023
August 2023
July 2023
June 2023
May 2023
April 2023
March 2023
February 2023
January 2023
December 2022
November 2022
October 2022
September 2022
July 2022
June 2022
May 2022
April 2022
March 2022
February 2022
January 2022
December 2021
November 2021
October 2021
September 2021
August 2021
July 2021
June 2021
May 2021
April 2021
March 2021
February 2021
January 2021
December 2020
November 2020
October 2020
September 2020
August 2020
July 2020
June 2020
May 2020
April 2020
March 2020
February 2020
January 2020
December 2019
November 2019
October 2019
September 2019
August 2019
July 2019
June 2019
May 2019
April 2019
March 2019
February 2019
January 2019
December 2018
November 2018
October 2018
September 2018
August 2018
July 2018
June 2018
May 2018
April 2018
March 2018
February 2018
January 2018
December 2017
November 2017
October 2017
September 2017
July 2017
June 2017
May 2017
April 2017
March 2017
February 2017
January 2017
December 2016
November 2016
October 2016
September 2016
August 2016
July 2016
June 2016
May 2016
April 2016
March 2016
February 2016
January 2016
December 2015
November 2015
October 2015
September 2015
August 2015
July 2015
June 2015
May 2015
April 2015
March 2015
February 2015
January 2015
December 2014
November 2014
October 2014
September 2014
August 2014
July 2014
June 2014
May 2014
April 2014
March 2014
February 2014
January 2014
December 2013
November 2013
October 2013
September 2013
August 2013
July 2013
June 2013
May 2013
April 2013
March 2013
February 2013
January 2013
December 2012
November 2012
October 2012
September 2012
August 2012
July 2012
June 2012
May 2012
April 2012
March 2012
February 2012
January 2012
December 2011
November 2011
October 2011
September 2011
August 2011
July 2011
June 2011
May 2011
April 2011
March 2011
February 2011
January 2011
December 2010
November 2010
October 2010
September 2010
August 2010
July 2010
June 2010
May 2010
April 2010
March 2010
February 2010
January 2010
December 2009
November 2009
October 2009
September 2009
August 2009
July 2009
June 2009
May 2009
April 2009
March 2009
February 2009
January 2009
December 2008
November 2008
October 2008
September 2008


JiscMail is a Jisc service.

View our service policies at https://www.jiscmail.ac.uk/policyandsecurity/ and Jisc's privacy policy at https://www.jisc.ac.uk/website/privacy-notice

For help and support help@jisc.ac.uk

Secured by F-Secure Anti-Virus CataList Email List Search Powered by the LISTSERV Email List Manager