Employers, the authors argue, have not demonstrated sustained interest or skill in managing their employees' healthcare. Physicians have the knowledge to run ACOs if given the right information, infrastructure and incentives, but their “traditional emphasis on autonomy” is the opposite of the standardization, measurement and group decision making needed for ACO success. Hospital administrators, they write, “have been trained and rewarded for their ability to fill beds,” so this mindset—along with decreased competition from consolidation—eliminates them from consideration.
Health plans—or hybrid organizations such as the Geisinger Health System, Intermountain Health System and Kaiser Permanente—have the capital, management expertise and information technology needed to create and manage ACOs, Fuchs and Schaeffer write. They add that health plans may be unpopular with stakeholders, “but the looming fiscal crisis” will require new partnerships with physicians and hospitals.
The authors also cite examples of how Aetna and WellPoint are already partnering with physicians and health systems to lower costs and improve quality.
“If the present fragmented structure of the U.S. healthcare system were replaced by well-organized ACOs paid by risk-adjusted capitation, improvement in one aspect of care in one plan would be rapidly copied by others,” the authors conclude. “Healthcare could begin to resemble industries in other sectors in which productivity gains diffuse rapidly from one firm to another.”