Journal Article

A Model For Integrating Independent Physicians Into Accountable Care Organizations

Patel, Pankaj H., Shields, Mark C., Manning, Martin, Sacks, Lee

2011

Overview

The Affordable Care Act encourages the formation of accountable care organizations as a new part of Medicare. Pending forthcoming federal regulations, though, it is unclear precisely how these ACOs will be structured. Although large integrated care systems that directly employ physicians may be most likely to evolve into ACOs, few such integrated systems exist in the United States. This paper demonstrates how Advocate Physician Partners in Illinois could serve as a model for a new kind of accountable care organization, by demonstrating how to organize physicians into partnerships with hospitals to improve care, cut costs, and be held accountable for the results. The partnership has signed its first commercial ACO contract effective January 1, 2011, with the largest insurer in Illinois, Blue Cross Blue Shield. Other commercial contracts are expected to follow. In a health care system still dominated by small, independent physician practices, this may constitute a more viable way to push the broader health care system toward accountable care. [PUBLICATION ABSTRACT]

• Publisher: The People to People Health Foundation, Inc., Project HOPE
• Subject: Accountability / Accountable care organizations / Commercial markets / Contracts / Cost analysis / Cost control / Cost reduction / Federal regulation / Health care / Health care expenditures / Health care policy / Health insurance / Health maintenance organizations / Health services / HMOs / Hospitals / Illinois / Independent practice associations / Information technology / Integrated care / Joint ventures / Legislation / Medicaid / Medical service / Medicare / Partnership / Partnerships / Patient Protection & Affordable Care Act 2010-US / Patient safety / Payment systems / PHOs / Physicians / Regulation / Reimbursement