Frank Diamond

Managing Editor

Remember when many predicted that accountable care organizations (ACOs) will save health care? A study by the Health Research and Educational Trust (HRET) states that “ACOs are entities willing to be held accountable for the costs and quality of care for a defined population of patients. When the ACA [Affordable Care Act] became law, such would-be organizations were likened by some observers to unicorns — they exist in our imagination, but no one has actually seen one.” (Certainly not Regina Herzlinger, PhD, as we reported here.)

Harsh, perhaps, but a recent study by the Centers for Disease Control and Prevention searched in vain for the cost savings in Medicare ACO pilots. The HRET says that “only 25% of physician practices have joined or formed ACOs, and another 15% plan to do so.”

Still, the trust looks on the bright side. “These findings clearly suggest that not only do unicorns exist but a significant number of physician practices find them attractive and they are propagating across the country.”

But are they propagating fast enough? Health care doesn’t need one unicorn; it needs a herd of them.

“Physician practices that are currently participating in ACOs appear to be relatively large, or to be members of an IPA or PHO, are less likely to be hospital-owned and are more likely to use more care management processes than nonparticipating partners,” states the study, “Physician Practice Participation in Accountable Care Organizations: The Emergence of the Unicorn.”

Practices that are already ACOs performed better in 25 measures of care management, patient engagement, and quality. That participating practices are large did not come as a surprise — smaller practices might lack the heft to do all of these things well.

The study states that 48% of practices have five or fewer doctors; and many others have fewer than 20. “The extent to which these practices can develop affiliations, alliances, or other forms of partnership to give them the size and infrastructure to participate in assuming risk for defined populations is a major question,” the study states.

Major indeed.

Frank Diamond is managing editor of Managed Care.

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