We have all seen it over the years as the health care sector responds to the latest government initiative. I wonder as the sector moves toward the ACO model, will it be with us long term? When you look at what is happening with acquisitions of physician practices it does make me also wonder if the reduction in reimbursements that are driving the acquisitions are also part of the larger focus to move the health care delivery system closer to a centralized model where ACOs would be the standard. Building an Accountable Care Organization structure is a challenge. There are not many existing ACOs to model your structure off. I was at the ACHE national meeting last March and one of the speakers explained “ACOs are like Unicorns, we have a good idea of what they should look like but nobody has seen one”.
Healthcare systems that have a large employed physician base are more likely to have a developed model and also have a clear advantage. In a model like a Cleveland Clinic, the primary care and specialist care givers are all employed by the entity. There are no negotiations relating to the revenues and how they would be shared amongst care givers and decision making for the ACO is focused within one entity. Trying to bring independent groups of physicians together with a health system will certainly be more challenging but providers are working on those models and finding creative ways to address those challenges. As we move into 2013 there is no doubt we will see more ACO models being established across the country but I think the advantage will definitely go to the larger physician employed organizations and the independent providers will have an uphill climb. Going forward it will be interesting to see if the ACOs of the future will look anything like what we expect them to look like.