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Elliott Fisher

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Fisher: One group could be a Medicare ACO


In this interview, Dartmouth’s Elliott Fisher, M.D. often called “The Father of Accountable Care Organizations,” talks about the direction of healthcare. Among his observations:

”Can narrow networks or MA plans be aligned with ACOs? I think so. You can imagine a policy environment in which a single organization could easily be a Medicare ACO, part of a Medicare Advantage plan or offered on the exchanges. The key would be to align organizational requirements, performance measures and payment incentives.”


Recommended repairs for ACO’s


They write that the recent  U.S. Department of Health and Human Services announcement by that Medicare will work to accelerate the transition to new payment models was  … ”an important step in the right direction. But without significant regulatory—and perhaps legislative—changes to current models, HHS’s ambitious goals are not likely to be achieved. ”
The writers conclude:
”First, the financial model for ACO’s should offer them a greater share of their initial savings (to help fund start-up costs), provide stronger incentives to induce and maintain participation from low-cost provider organizations, and foster alignment of payment schemes across all payer types—not just in Medicare. This strategy will encourage the growth of shared-savings models and motivate high-performing healthcare systems to join the ACO programs.”The second strategy would improve patient engagement in ACOs by modifying how Medicare beneficiaries are assigned to an ACO: Beneficiaries should be given the opportunity to choose to join their ACO; for those not actively choosing, those eligible should be assigned at the beginning of the year (so that their ACO can contact them). Medicare should also test a benefit design that uses modest financial incentives to encourage patients to seek care within their ACO or from providers outside the ACO whom the ACO recommends. Simultaneously, to make such incentives possible, supplemental Medicare plans should be restricted from covering first-dollar beneficiary costs for non-ACO services.”

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