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Best performing ACO weakened by flawed model

Bellin Theda-Care Health Partners is an accountable care organization (ACO) in Wisconsin that has participated in the Medicare Pioneer ACO pilot project.  Despite doing well in the pilot project, Bellin Theda-Care has found that there are shortcomings in the Medicare ACO model that lead to decreased reimbursement.  Why?  The ACO has implemented various improvements, such as measures to decrease readmissions, that have decreased utilization for patients.  The ACO shares in savings associated with the Medicare patients, but not for the non-Medicare patients who also benefit from the improvements.  For these patients, there is a decrease in revenue, with no opportunity for the providers to share in the savings.  The authors argue for the establishment of multipayer ACOs to address this inequity.

Source: Toussaint, J., Milstein, A., and Shortell, S.  How the Pioneer ACO model needs to change: lessons from its best-performing ACO.  JAMA;310(13):1341-1342, Oct. 2, 2013.  Click here for publisher website: http://jama.jamanetwork.com/article.aspx?articleid=1745687  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

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