Putting Genie Back in the Bottle...ACO's Don't Work

[drusso]

---

Members don't see this ad.

http://www.nasi.org/press/releases/2015/02/press-release-study-urges-greater-financial-disclosure-no

"According to the study, IDNs have "operated under a halo of presumed societal benefits (quality, efficiency, care integration, etc.) for the better part of four decades with remarkably little evidence that these benefits in fact exist. It is still possible that these societal benefits of IDNs exist. But if they do, given the opacity of present IDN disclosure of key operating information, they eluded us in this preliminary investigation. If public policy is to continue fostering IDN growth and development, a more solid evidentiary foundation for this form of medical care organization seems essential. The mere presumption of societal benefits of IDN formation or operations is no longer tenable as a policy principle."

Other key study findings include:

• There is little evidence that integrating hospital and physician care has helped to promote quality or reduce costs, and growing evidence suggests that the opposite is true, and that hospital-physician integration has raised both physician costs and hospital prices.
• Hospital integration into health plan operations and risked-based contracting was not associated with either clinical efficiency, such as shorter lengths of stay, or financial efficiency, such as lower charges per admission.
• The available evidence suggests that the more providers invest in IDN development, the lower their operating margins and return on capital. Diversification into more businesses is associated with negative operating performance.
• There are few or no scope economies within health plans, hospitals or physician groups—let alone between these lines of business contained within IDNs. Provider-sponsored insurance plans face similar problems regardless of whether they were formed by hospitals or physician groups: poor capitalization, lack of actuarial and underwriting expertise, limited marketing capability, adverse selection risk—attracting sicker than average enrollees— and inability to reach sufficient enrollment scale.

 

[emd123]

Of course they don't work. It's an absurd concept to begin with. None of these jokers have any goal of "saving money."

 

[hyperalgesia]

http://www.nasi.org/press/releases/2015/02/press-release-study-urges-greater-financial-disclosure-no

"According to the study, IDNs have "operated under a halo of presumed societal benefits (quality, efficiency, care integration, etc.) for the better part of four decades with remarkably little evidence that these benefits in fact exist. It is still possible that these societal benefits of IDNs exist. But if they do, given the opacity of present IDN disclosure of key operating information, they eluded us in this preliminary investigation. If public policy is to continue fostering IDN growth and development, a more solid evidentiary foundation for this form of medical care organization seems essential. The mere presumption of societal benefits of IDN formation or operations is no longer tenable as a policy principle."

Other key study findings include:

• There is little evidence that integrating hospital and physician care has helped to promote quality or reduce costs, and growing evidence suggests that the opposite is true, and that hospital-physician integration has raised both physician costs and hospital prices.
• Hospital integration into health plan operations and risked-based contracting was not associated with either clinical efficiency, such as shorter lengths of stay, or financial efficiency, such as lower charges per admission.
• The available evidence suggests that the more providers invest in IDN development, the lower their operating margins and return on capital. Diversification into more businesses is associated with negative operating performance.
• There are few or no scope economies within health plans, hospitals or physician groups—let alone between these lines of business contained within IDNs. Provider-sponsored insurance plans face similar problems regardless of whether they were formed by hospitals or physician groups: poor capitalization, lack of actuarial and underwriting expertise, limited marketing capability, adverse selection risk—attracting sicker than average enrollees— and inability to reach sufficient enrollment scale.

The more published studies like this, the better.

 

[Ducttape]

imho, the last time an IDN worked, it was with an entire community in support. it doesnt work when money is an integral part of the equation.

 

[SeniorWrangler]

I always thought it was mostly about control rather than saving money -- with ACO's in place, the government and insurers only have to negotiate with a relative handful of hospital CEO's and managers instead of thousands of doctors with strongly held opinions.