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ACOs Could Be the New Blue Unicorn


Pundits across the spectrum continue to hawk accountable care organizations (ACOs) as the solution to our health care cost woes. Today it’s Jenny Gold, arguing at Wonkblog that ACOs could be the cost-control “unicorn” we’ve been looking for all this time. Gold is pivoting off a new study that found “spillover effects” from a Massachusetts ACO: not only did the patients in the ACO itself experience savings; Medicare patients from the same hospital but outside the ACO also saved. More:

“The spillover savings in Medicare that we found suggest that at least some of the interventions providers adopted […] changed the way care was delivered for all patients,” assistant professor J. Michael McWilliams, said in a news release […]

The findings “suggest that provider groups are willing—and able—to make systemic changes that result in higher-value care for patients across the board.” And that means they’ll likely be willing to enter into similar contracts with additional insurers, which could mean a rapid transition to coordinated care throughout the system.

The rosy picture painted by thus study is complicated, however, by the rest of the data out there. The most systematic study to date of the 32 ACOs from the Obamacare pilot program found that only slightly more than half of the ACOs saved money for their patients, and that two decided to drop out of the program altogether. But the problem with ACOs is not just that the data is, so far, inconclusive; it’s that the theory behind them is ultimately provider-centric, arguing that if we want to control costs we have to pursue technocratic tinkering on the provider side of health care rather than shifting more responsibility to the consumer.

This “provider-oriented approach” involves massive and growing government intervention. In theory, government regulations empower consumers by pressuring providers on their behalf, but in practice, all too often in our corrupt, lobby ridden system the regulators and regulation writers are bent in the direction of serving vested interests and producers. Empowering consumers by actually empowering consumers ensures that the system is being policed not by an easily corruptible, monolithic regulatory regime in DC but by millions of people who have a vested interest in getting the best services for the best price.

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  • Jane the Actuary

    Empowering consumers is nice, in principle, but there’s no transparency. The consumer has no way of price-shopping healthcare, in most instances, and has no way to adequately judge the effectiveness of potential treatments, both by the lack of effectiveness studies for many conventional treatments and by the inability to interpret the statistics of any such studies. Read How We Do Harm, or similar books, about patients, trusting their doctors’ judgment, and being overtreated for their condition in ways that caused serious harm. Catastrophic plans in themselves are not going to solve the health care cost crisis.

  • qet

    This is absurd. Long ago believers in the USSR would be allowed to visit model collective farms, where output was high and everyone was happy, and then on the basis of these manufactured models proclaim that the data showed that collectivized agriculture worked. These sporadic one-off studies popping up here and there lately that purport to show that some feature of the ACA will work as or better than advertised are like those model collective farms. We all know how effective the entire Soviet nation of collectivized agriculture was. A single ACO success story, and one suspects that its success was manufactured by interested parties, is evidence of nothing.

  • Jacksonian_Libertarian

    “Empowering consumers by actually empowering consumers ensures that the system is being policed not by an easily corruptible, monolithic regulatory regime in DC but by millions of people who have a vested interest in getting the best services for the best price.”


    • Boritz

      Government empowers only government, not consumers. This idea is doomed by the first two words.

      • bpuharic

        Nonsense. Antitrust legislation is an example of why you’re wrong.

        THe right wing fundamentalist view of govt is anarchist and bizarre

  • bpuharic

    Our system is corruptible because American conservatives believe in 1 dollar 1 vote. That’s why 0.01 percent of all voters contributed 28 percent of contributions in the last election. They, with their ‘libertarian’ views, have deregulated elections and given ‘free speech’ to corporations and individuals with unlimited funds to buy politicians.

    The fact is every single govt sponsored healthcare system in the world costs less than ours does. It’s not govt regulation that’s the problem. It’s the right wing belief, as they showed with Medicare Part D, that the system must be rigged so the public interest is defined as allowing huge profits to be made off of gutting the middle class.

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