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Title : Important Question From Medicare Demonstration Projects: Most Null Works
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Important Question From Medicare Demonstration Projects: Most Null Works

I volition propose that close of us believe the mode to command wellness tending costs, in addition to at the same fourth dimension keep or ameliorate quality, is to both role the managed tending tools nosotros convey developed over the years, in addition to peradventure to a greater extent than importantly, modify the payment incentives thus that both toll command in addition to character are upper close inward the minds of providers in addition to payers.

The Congressional Budget Office (CBO) has simply released an of import review of Medicare's results inward testing those ideas. The tidings is non good.

From the Why ACOs Won't Work, I argued that this approach couldn't function unless nosotros modify the game--we modify how providers are paid thus that in that place is a meaning downside if results aren't achieved. I said, "Here’s a flash for the policy wonks pushing ACOs: They exclusively function if the provider gets paid less for the same patient population." At to the lowest degree i of the studies the CBO is citing would seem to back upward that notion--but exclusively one.

When Medicare outset announced their ACO demonstration project, the providers all howled--they were beingness lay at likewise much risk for likewise picayune return. The feds in addition to thus lowered the bar past times improving the odds in that place could exclusively hold out winners in addition to non losers––eliminating player risk inward the outset of 2 ACO tracks. The minute rail continues to deport risk but offers larger potential rewards.

Medicare policymakers may convey had no selection but to placate the providers inward social club to entice them into the novel organisation inward social club to instruct it off the ground. That said, Medicare's strategy of overpaying HMOs to entice them into the Medicare Advantage concern hasn't precisely worked out toward the destination of lowering costs.

This CBO report makes it rattling clear that ACOs alongside picayune risk, simply layering these tools over the meridian of the fee-for-service system, is a pointless exercise. When nosotros simply supply incentives to do the correct thing, nosotros don't do the correct thing.

What nosotros remove to hold out testing in addition to perfecting is the combination of the best tools nosotros convey in addition to meaning risk--changing the payment incentives for real.

Unless ACOs, or whatsoever other managed tending scheme for that matter, start out paying less, in addition to the tools nosotros convey are in addition to thus used to accomplish a profitable result, in that place is no show in that place volition hold out savings.

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