title: ACO model should encourage efficient care delivery.
abstract: The independent Office of the Actuary for CMS certified that the Pioneer ACO model has met the stringent criteria for expansion to a larger population. Significant savings have accrued and quality targets have been met, so the program as a whole appears to be working. Ironically, 13 of the initial 32 enrollees have left. We attribute this to the design of the ACO models which inadequately support efficient care delivery. Using Bellin-ThedaCare Healthcare Partners as an example, we will focus on correctible flaws in four core elements of the ACO payment model: finance spending and targets, attribution, and quality performance.
authors.affiliation: ThedaCare Center for Healthcare Value, 100 W. Lawrence Street, Suite 422, Appleton, WI 54911, USA. Electronic address: jtoussaint@createvalue.org.
authors.forename: John
authors.initials: J
authors.lastname: Toussaint
authors.affiliation: Bellin-ThedaCare Healthcare Partners, USA.
authors.forename: David
authors.initials: D
authors.lastname: Krueger
authors.affiliation: Center for Healthcare Organizational and Innovation Research, School of Public Health, UC Berkeley, CA, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Shortell
authors.affiliation: Stanford Clinical Excellence Research Center, School of Medicine, Stanford University, USA.
authors.forename: Arnold
authors.initials: A
authors.lastname: Milstein
authors.affiliation: Harvard University, Department of Economics, Harvard University, and NBER, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Cutler
mesh_terms: D060866:Accountable Care Organizations; D003695:Delivery of Health Care; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D006278:Medicare; D058991:Patient Protection and Affordable Care Act; D011787:Quality of Health Care; D014481:United States
keywords: Accountable Care Organizations; Payment redesign; Pioneer ACO; Risk adjusted global