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ACOs: In Theory and in Practice

by John Voith, Director of Transaction Services

"In theory, theory and practice are the same. In practice, they are not.”

An athenahealth client recently reminded me of this quote attributed to Michelangelo, which nicely summarizes one of the main themes that emerged as part of the America Health Insurance Plans (AHIP) Accountable Care Organization (ACO) Summit in Washington D.C. on Wednesday. In theory, ACOs lead to more integrated care and sustainable cost growth throughout the health care system; in practice, ACOs are creating issues in the market that should be proactively addressed via regulation and the forming of new ACOs.

Some details about this first-ever Summit: The idea originated from a conversation that our CEO Jonathan Bush had late last year with AHIP’s CEO Karen Ignagni. During their conversation, the two leaders discussed health plans and independent practices’ shared concerns regarding some of the more acute, unintended consequences of the ACO, model. One particular concern is that market consolidation under large hospital systems—including the acquisition of independent and small-practice physicians for the purpose of gaining market power—seems to be increasingly prevalent. Additionally, smaller practices are often excluded from forming ACOs due to structural impediments (e.g. regulatory bias, staffing constraints, reimbursement effects).

The AHIP ACO program included presentations from a wide variety of experts, including an antitrust enforcement officer from the Department of Justice, private sector antitrust attorneys, a self-described healthcare "futurist," and athenahealth board member Charlie Baker. 150 key influencers attended the event, from D.C. leaders and hospital executives, to caregivers and commercial payers.

athenahealth sponsored a portion of the program, which included Jonathan describing our efforts to help clients thrive in risk-based reimbursement models while remaining independent; a lively discussion between Jonathan and Congressman Bill Cassidy, MD of Louisiana; and a panel of our clients: Mark Girard, MD, from Steward Health Care Network, David Slingerland, MD, of Hudson Headwaters Health Network and Marc Feingold, MD.

I viewed the summit as a meaningful call to arms for legislators, regulators, payers, hospital executives, and providers alike. We were excited to play a part and proud of our clients for providing tangible examples of how ACO regulation is affecting and influencing the market. And we are looking forward to continue advocating for independent providers and to creating services that enable clients to thrive—no matter the reimbursement model.

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