Opinion and analysis on managing care from experts and KOLs

I See Smirking ACO Critics

Jessica Cherian, PharmD, RPh

The Pioneer Accountable Care Organization (ACO) was an additional ACO model offered by Medicare, designed for groups that were already experienced in coordinating patient care across the care continuum. The shared-savings payment policy in this case is aligned with higher levels of both sharing and risk than that of the basic Shared Savings Program. Many had high hopes for the Pioneer groups and anticipated positive results when it came time for reporting in 2013.

Now, over a year later, with 9 of 32 Medicare Pioneer ACOs already dropped out of the program and only 13 able to generate shared savings, many, along with the Medicare Payment Advisory Committee (MedPac) are considering new ways to attract providers and strengthen the ACO establishment. Most recently, MedPac has started to contemplate the creation of a “Medicare Select ACO supplemental plan” which would involve a lower cost share for patients. This idea aims to improve patient loyalty to ACOs, since members may choose to seek care outside of ACOs while ACOs are still financially responsible for the members.

Critics of ACOs have long been questioning patient loyalty, among many other factors that could affect ACO success. After hearing of Medicare's interest, I couldn’t help but think that these same people are discreetly saying “I told you so.” Despite what I might imagine to be the remarks of ACO cynics, experts are still enthusiastic when it comes to the future of these models.

Jessica Cherian, PharmD, RPh, is a clinical adjunct faculty member at Temple University in Philadelphia and is a community pharmacist.

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