Can ACOs Survive the Demise of Obamacare?

Health policy expert sees brighter days ahead

As Republicans debate exactly how to repeal and replace the Patient Protection and Affordable Care Act (PPACA), the future of accountable care organizations (ACOs)––created by the PPACA to improve care and reduce costs––hangs in the balance. But health policy expert Paul Keckley, PhD, managing editor of The Keckley Report, predicts that even if Obamacare ends up in history’s dust bin, ACOs will survive. They will just need to adapt to the new regulatory landscape.

“ACOs are here to stay,” Keckley wrote in a post for Hospitals & Health Networks. “How they fit into a medical group or health system’s contracting and population health strategies will change as regulations like MACRA [the Medicare Access and CHIP Reauthorization Act of 2015] kick in and as employers, insurers, Medicare, and Medicaid assess their value.”

In 2017, 570 ACOs will participate in Centers for Medicare and Medicaid Services (CMS) models, including the Shared Savings Program, the Next Generation ACO Model, and the Comprehensive ESRD [End-Stage Renal Disease] Care Model.

Tom Price, the new head of the Department of Health and Human Services, has made it clear that he doesn’t support some value-based care initiatives, such as Medicare’s mandatory bundled payments for hip- and knee-replacement surgeries.

To survive, ACOs must focus on primary care-driven care coordination, according to Keckley. “From these primary-care centric models, virtual ACOs that incorporate rural health and teleconnectivity, and clinical models that include social determinants of health in assessing risks and care coordination tactics will evolve,” he wrote.

Keckley also predicted that the CMS will change quality measures and simplify reporting requirements under Medicare Shared Savings Program (MSSP) ACOs. And if Congress adopts Medicaid block grants, he expects Medicaid ACOs will be a growth opportunity.

Sources: H&HN; March 1, 2017; and FierceHealthcare; March 1, 2017.