Accountable Care Organizations: The Case For Flexible Partnerships Between Health Plans And Providers
Accountable Care Organizations: The Case For Flexible Partnerships Between Health Plans And Providers
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DOI：
10.1377/hlthaff.2010.0782
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发表时间：
2011-01-01
期刊：
影响因子：
9.7
通讯作者：
Goldsmith, Jeff
中科院分区：
文献类型：
--
作者：
Goldsmith, Jeff
根据《平价医疗法案》，新的医疗保险和医疗补助创新中心将指导医疗保健支付和提供方面的一些实验项目。其中最雄心勃勃的改革模式是责任医疗组织（ACO），它将提供经济奖励，如果他们能够减少医疗保险的成本增长在他们的社区。然而，供应商主导的成本管理尝试的惨淡历史表明，该计划不太可能实现其目标。更重要的是，如果ACO在供应商中促进更多的市场集中，它们有可能将成本转移到私人保险公司身上。本文提出了一个更灵活的支付模式，为供应商和私人保险公司，将医疗保健服务分为三类：长期，低强度的初级保健;计划外护理，包括计划外的紧急服务;和主要的临床干预，通常涉及住院或有组织的门诊护理。每类护理的支付方式不同，每类护理对提供者来说都有不同的财务风险。然后，将鼓励卫生计划为提供者提供后勤和分析支持，以管理这些类别的卫生费用。
Under the Affordable Care Act, the new Center for Medicare and Medicaid Innovation will guide a number of experimental programs in health care payment and delivery. Among the most ambitious of the reform models is the accountable care organization (ACO), which will offer providers economic rewards if they can reduce Medicare's cost growth in their communities. However, the dismal history of provider-led attempts to manage costs suggests that this program is unlikely to accomplish its objectives. What's more, if ACOs foster more market concentration among providers, they have the potential to shift costs onto private insurers. This paper proposes a more flexible payment model for providers and private insurers that would divide health care services into three categories: long-term, low-intensity primary care; unscheduled care, including unscheduled emergency services; and major clinical interventions that usually involve hospitalization or organized outpatient care. Each category of care would be paid for differently, with each containing different elements of financial risk for the providers. Health plans would then be encouraged to provide logistical and analytic support to providers in managing health costs in these categories.