Talk:Accountable care organization

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What's the difference between an ACO and an HMO?[edit]

Should there be two pages, one for ACO and one for HMO? Supposedly Kaiser is an ACO according to this page but go to the Kaiser page and it says that it's an HMO. What's the justification for two pages? TMLutas (talk) 02:29, 30 June 2011 (UTC)[reply]

Almost a generation ago, public anger over the incentives that drove some managed-care plans to stint on care led to the downfall of many of them. The design of ACOs is fraught with complexity, which suggests that managed care's failure still lingers in the minds of many policymakers. Although many of them rail against the incentives that drive fee-for-service medicine, their actions underscore a reluctance to abandon it. Their uncertainty stems from the unsettling absence of an acceptable alternative. ACOs are therefore built on a fee-for-service chassis and are not closed networks. CMS states that Medicare beneficiaries will be free to seek care from any provider — which will limit ACOs' ability to fully control the cost and quality of care delivered to their assigned beneficiaries.doi:10.1056/NEJMp1103603

Jesanj (talk) 13:14, 30 June 2011 (UTC)[reply]
Not really responsive to my question. ACOs by your article seem not to exist yet. So what we've really got are the retreads, the evolved HMOs. For propaganda purposes the administration and allies want there to be a break, but that's a political matter and certainly NOT consistent with NPOV. The other side stresses continuity, again for propaganda purposes. Inconsistently calling something an HMO and an ACO on different pages has to get resolved. I don't see any justification for current practice. TMLutas (talk) 20:49, 2 July 2011 (UTC)[reply]
If ACOs don't exist yet that would be another difference wouldn't it? If you feel so strongly this article is a NPOV violation, you should take it up at the WP:NPOVN. I look forward to seeing that discussion. Jesanj (talk) 16:28, 3 July 2011 (UTC)[reply]
At this point, I view things to be confused, not wrong-headed and in need of some sort of outside intervention. Or are you spoiling for a fight? You're the one bringing up the idea that ACOs aren't in existence. If that's the case, the article should be more future tense oriented, shouldn't it? For instance, instead of a first sentence "An accountable care organization (ACO) is a type of payment and delivery reform model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients." you could have "An accountable care organization (ACO) will implement a type of payment and delivery reform model that shall seek to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients. "
What I don't see is the current text being really sustainable without further development. Can we at least agree on that? TMLutas (talk) 03:10, 4 July 2011 (UTC)[reply]
ACOs are indeed an evolved approach after consumer backlash with HMOs in the 90s. ACOs differ from HMOs in two key ways: specifically for Medicare ACOs patient provider choice is not limited (as opposed to an managed care network); also in ACOs reimbursement/profit may be held from providers if quality benchmarks are not met or improved on. — Preceding unsigned comment added by Pajer21 (talk • contribs) 04:24, 17 June 2015 (UTC)[reply]

Kaiser does address the question "What is the difference between an ACO and an HMO" please see bottom of page at: http://khn.org/news/aco-accountable-care-organization-faq/. Basicaly, ACO is an evolution of the HMO, or an attempt to further the HMO philosophy (cost containment, preventative care, etc) while addressing some of the issues that brought about the demise of many HMOs during the 1970's (lack of provider choice, cost controls trumped patient satisfaction). The definition is not what matters. What matters is that we have 'no choice' but to move forward and seek a solution to the cost of healthcare issue. Do you know what it costs today to buy a health insurance policy for yourself (without your employer paying for half of it)? Its not reasonable. In my opinion, part of the problem is that there are many non-compliant patients out there (smokers, obesity, etc.). The insures should place more effort on incenting the patients as well. 2601:283:4601:3C8B:FDA5:D2F7:1DA4:8C41 (talk) 21:34, 11 March 2016 (UTC)TF, many years in healthcare finance.[reply]

Outdated[edit]

This article is outdated. The main sources are from 2009, 2010 and 2011. Many of the programs that were proposed in these sources now have articles in the peer reviewed journals describing how they failed to accomplish their goals.

For example, under "Cost savings," the article cites a 2011 CMS estimate of how much ACOs will save 2012–2015. I'm writing this in 2016, and I've seen many articles in NEJM and other peer-review journals which concluded that the ACOs failed to achieve their goals.

Also the section on "Pioneer ACO Savings" is written entirely from a CMS press release (primary source, not a WP:RS) and seems to be cherry-picking the data. The articles in the peer-reviewed journals (WP:RS and WP:MEDRS) concluded that the improvements were not significant.

Another problem is that the quality measurements didn't work. http://jama.jamanetwork.com/article.aspx?articleid=2109967
Concerns About Using the Patient Safety Indicator-90 Composite in Pay-for-Performance Programs
Ravi Rajaram, MD1; Cynthia Barnard, MBA2; Karl Y. Bilimoria, MD, MS3

JAMA. 2015;313(9):897-898. doi:10.1001/jama.2015.52.

The best way to rewrite this article would be to blank the whole thing and start from scratch, using peer-reviewed journals (rather than primary government sources) and using the current data, based on the results of the programs, rather than claims from 2011. --Nbauman (talk) 15:49, 29 June 2016 (UTC)[reply]

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Other countries[edit]

We are developing similar organisations in England, and I am not sure whether it is sensible to combine them into the same article, as the context is very different. I suppose I could just rely on the difference in spelling of accountable care organisation to write a different article. On the other hand the contrasts could be illuminating, and I would be very surprised if there are not similar things in other countries. What do people think?Rathfelder (talk) 09:51, 4 October 2016 (UTC)[reply]

Replying four years later... @Rathfelder, I do agree it would be useful to have a single article for when people search for “accountable care organization”, and that somehow integrates the differences. However, that would mean somehow reorganizing this page to have most of these sections under some kind of “US” section, or something similar.
I see you added a small section on “England” here and also created the page accountable care systems. Do you think that is sufficient? Or would you be interested in still doing something with this page?
(I have no background or expertise about ACOs. I just learned about them listening to a brief presentation yesterday about a local Vermont ACO.) - Dyork (talk) 08:37, 12 March 2020 (UTC)[reply]
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