Editor's Memo

Putting ACOs Together May Be an Uphill Fight

John Marcille

The history of health care over the past 30 years has included a long list of organizational types that come and go. Some are fads, some are promoted and subsidized by government, some are more talked about than actually undertaken.

Accountable care organizations — ACOs — certainly fall into this category. Our cover story is the latest to join the parade, whose other members include HMOs, PPOs, physician practice-management companies, shared-services organizations, integrated delivery systems, and so on.

In this case, the concept is getting a boost from the federal government under the Patient Protection and Affordable Care Act, which should count for something. Yet as you read the article, you realize that there’s a lot to be done, and while the effort to integrate payers and providers in new alliances promises attractive results, there are many elements to be fit together.

Each participant will have new responsibilities for improving patient care, where each will face serious financial threats, where each will have to create a new internal culture. This is all easier said than done, and I think that is clear in the article, although the authors are upbeat about it.

Jeff Goldsmith, the well-known, perceptive, and loquacious consultant, is less optimistic (see my interview with him), to put it mildly.

Elsewhere in this issue, you will find a discussion of the frustrating management challenges of chronic fatigue syndrome, and a look at how specialty pharmacy management may change — in some cases, is already changing — over the next few years in response to the characteristics of drugs in the pipeline and the increasing need to keep a lid on costs. And we have a slightly whimsical look at what one pharmacy benefit manager is doing to create a bond directly with members.  

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