Right now, the portion of lives covered by ACOs in the U.S. is relatively small, estimated at just 6% by researchers tracking the ACO movement. But it's hard to argue that soon that number will skyrocket, given the intense level of interest that payers, doctors and hospitals have shown in the model.
The thing is, I'm not sure the parties involved are being completely honest with themselves about the flaws in the model.
You hear a lot of happy talk about savings, care coordination and even money coming back to the providers through shared savings models. But you don't hear much about the problems.
Here are three:
1. Not all doctors want to be in an ACO
There are physicians who believe that being in an ACO will benefit the practice by, if nothing else, giving them more leverage in negotiations with payers. But the truth is, many physicians fear that being absorbed into an ACO will limit their autonomy significantly.
One gastroenterologist I spoke with said it best: "We're not going to be part of an ACO and have them make the rules. We're going to be the best in the market for quality and price, and the ACOs will have to come to us."
2. Payer-driven ACOs are a deal with the devil
As we've been reporting over the last several weeks, the big health insurance players are building their own versions of ACOs with regional health systems and affiliated physician groups.
One way to look at this -- the glass half-full version -- is that this puts payers and providers on the same page. On the other hand, one might say that providers now have virtually no leverage to fight for prices to their liking, as demands for higher compensation could dissolve a highly complex and expensive deal.
Bottom line, providers' and payers' interests don't match up closely enough to justify such a deal in most cases.
3. ACOs impose more bureaucracy
Medical practices and hospitals already fight a daily war to get themselves paid by health plans. What happens when they're working in a big, overarching entity?
Some clinical good, possibly, as early evidence does suggest that ACOs lower emergency department visits, readmissions and other forms of health relapse. Despite their being something of a bridge, ACOs don't really align the interests of doctors and hospitals yet. That piles the demands of the ACO on top of the demands of payers. I predict that getting paid in ACOs won't be much fun.