We were recently asked, “Will commercial MCOs follow the ACO model?”
To answer one question with another: “Who is following whom?”
The ACO model creates a network of providers who coordinate care delivery to improve its quality and cost-effectiveness. Described that way, ACOs are following in the footsteps of an earlier MCO model, 1980s HMOs.
Of course, when you follow from a distance, a lot can change. The ACO model offers:
Patients see any doctor they wish, inside or outside the ACO network. Providers have reimbursement alternatives—including capitation—and can join multiple ACOs. Networks can include primary care practices, hospitals, specialty clinics and social service providers.
More to improve quality; fewer to reduce costs by reducing care.
Electronic health records enable providers to coordinate their efforts, even without physical proximity.
More control—and responsibility—for care providers
HMOs are insurer-based, organizations…
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