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Accountable Care Organizations: A New Paradigm for Health Care Delivery?

Friday, May 13, 2011

In addition to expanding coverage to 32 million previously uninsured Americans, the health reform law of 2010 aims to improve the health of the population and the quality of health care delivery, while reducing costs. One tool to pursue these goals is the creation of a national voluntary program for accountable care organizations (ACOs). The law authorizes Medicare, beginning next year, to contract with accountable care organizations in a Medicare Shared Savings Program. ACOs provide financial incentives to improve the coordination and quality of care for Medicare beneficiaries, while reducing costs.

The Centers for Medicare and Medicaid Services (CMS) has released a proposed rule for implementing the new program, laying out requirements for groups of providers to qualify as ACOs and methodologies for monitoring and assessing ACO performance and distributing shared savings.

The ACO provision and the proposed rule raise many questions. How can health care providers organize to provide more patient-centered, coordinated, accountable care? How will the new program affect the relationships among primary care providers, specialists, and hospitals? Will coordination among providers mean concentration of market power and higher prices? What lessons can be learned from existing ACOs about achieving better care, better health, and lower costs? What other issues need to be addressed before the CMS proposed rule on the Medicare Shared Savings Program for ACOs becomes final?

To address these and related questions, the Alliance for Health Reform and The Commonwealth Fund sponsored a May 13 briefing. Panelists were: Rick Gilfillan, CMS Center for Medicare and Medicaid Innovation; Susan DeVore, Premier Healthcare Alliance; William Jessee, Medical Group Management Association; and Mark McClellan, Engelberg Center for Health Care Reform at the Brookings Institution. Stuart Guterman of Commonwealth and Ed Howard of the Alliance co-moderated.


 Ed Howard, Alliance for Health Reform, Moderator
 Stuart Guterman, The Commonwealth Fund, Moderator
 Rick Gilfillan, CMS Center for Medicare and Medicaid Innovation, Speaker
 Susan DeVore, Premier Healthcare Alliance, Speaker
 William Jessee, Medical Group Management Association, Speaker
 Mark McClellan, Brookings Institution, Speaker
(Click on the camera icon to see a video of the speaker's presentation.)

Transcript, Event Summary and/or Webcast and Podcast

Transcript: Transcript (Adobe Acrobat PDF), 5/13/2011
Event Summary: Event Summary (Adobe Acrobat PDF), 5/13/2011
Full Webcast/Podcast: Accountable Care Organizations: A New Paradigm for Health Care Delivery?

The full webcast and podcast for this briefing, as well as videos of individual speakers' presentations, are provided by Kaiser Family Foundation.

Speaker Presentations

Susan DeVore Presentation (PowerPoint), 5/13/2011
Stuart Guterman Presentation (PowerPoint), 5/13/2011
William Jessee Presentation (PowerPoint), 5/13/2011
Mark McClellan Presentation (PowerPoint), 5/13/2011

(If you want to download one or more slides from these presentations, contact us at info@allhealth or click here for instructions.)

Source Materials

Speaker Biographies (Adobe Acrobat PDF), , 5/13/2011
Materials List (Adobe Acrobat PDF), , 5/13/2011
Experts Sourcelist (Word Document), , 5/13/2011
Agenda (Adobe Acrobat PDF), , 5/13/2011
Event Summary (Adobe Acrobat PDF), , 5/13/2011

Offsite Materials (briefing documents saved on other websites)

ACO Toolkit, Engelberg Center for Health Reform and The Dartmouth Institute, 1/1/2011
Accountable Care Organizations: Improving Care Coordination for People with Medicare, HHS Fact Sheet., 3/31/2011
Launching Accountable Care Organizations — The Proposed Rule for the Medicare Shared Savings Program, The New England Journal of Medicine, 3/31/2011
- Berwick, Donald M.
Private-Payer Innovation In Massachusetts: The ‘Alternative Quality Contract, Health Affairs, 1/1/2011
- Chernew, Michael et al
Driving Population Health Through Accountable Care Organizations, Health Affairs, 1/1/2011
- DeVore, Susan, R. Wesley Champion
Accountable Care Organizations- Accountable for What, to Whom, and How, Journal of the American Medical Association, 10/20/2010
- Fisher, Elliott S and Stephen M. Shortell
FTC, DOJ Seek Public Comment on Proposed Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations, Federal Trade Commission, 3/31/2011
Accountable Care Organizations: The End of Innovation in Medicine?, American Enterprise Institute for Public Policy Research, 2/1/2011
- Gottlieb, Scott
High Performance Accountable Care: Building on Success And Learning From Experience, The Commonwealth Fund, 4/1/2011
- Guterman, Stuart
The ACO Model---Three Year Financial Loss?, The New England Journal of Medicine, 3/23/2011
- Haywood, Trent and Keith Kosel
The ACO Regulations — Some Answers, More Question, The New England Journal of Medicine, 4/13/2011
- Iglehart, John K.
Overweight And Out Of Shape: ACO Regs Need A Major Makeover, Health Affairs Blog, 4/7/2011
- Klar,Ron
Proposed CMS Regulation Kills ACOs Softly, Health Affairs Blog, 4/6/2011
- Lieberman, Steven
Accountable Care Organizations: A Framework For Evaluating Proposed Rules, Health Affairs Blog, 3/31/2011
- McClellan,Mark and Elliott Fisher
Health Policy Brief: Accountable Care Organizations (Adobe Acrobat PDF),Health Affairs, 8/13/2010
- Merlis, Mark
The Proposed Accountable Care Organization Antitrust Guidance: A First Look, Health Affairs Blog, 4/14/2011
- Miller, Joe
Why Accountable Care Organizations Won’t Deliver Better Health Care—and Market Innovation Will, The Heritage Foundation, 4/18/2011
- Numerof, Rita
Proposed Rules for Accountable Care Organizations Participating in the Medicare Shared Savings Program: What Do They Say?, The Commonwealth Fund, 3/31/2011
New ACO Rules Outline Gains and Risks for Doctors, Hospitals, Kaiser Health News, 3/31/2011
- Rau, Jordan, et al
The Potential of Global Payment: Insights from the Field, The Commonwealth Fund, 2/18/2010
- Robinow, Ann
Summary of Proposed Rule Provisions for Accountable Care Organizations under the Medicare Shared Savings Program (Adobe Acrobat PDF),Centers for Medicare & Medicaid Services, 3/31/2011
Perspectives on Health Reform—Achieving Accountable Care: Are We on the Right Path, The Commonwealth Fund, 4/14/2011
- Zezza, Mark A. and Stuart Guterman


Stuart Guterman of The Commonwealth Fund describes how Accountable Care Organizations can help lead to a high performance health system. From the May 13 briefing cosponsored by The Fund.

Richard Gilfillan, acting director of the Center for Medicare and Medicaid Innovation at CMS, discussed the proposed characteristics of Accountable Care Organizations at the May 13 briefing cosponsored by The Commonwealth Fund.

Susan DeVore, president and CEO of the Premier health care alliance, discussed what hospitals like and don't like about the proposed rules governing Accountable Care Organizations. From the May 13 briefing cosponsored by The Commonwealth Fund.

William Jessee, MD, of the Medical Group Management Association, offered physicians' suggestions for improving Accountable Care Organizations. From the May 13 briefing cosponsored by The Commonwealth Fund.

Mark McClellan, MD, of the Brookings Institution, discussed how to make Accountable Care Organizations successful at the May 13 briefing cosponsored by The Commonwealth Fund.


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