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How ACO ‘triple whammy’ undermines Triple Aim

 

This HealthAffairs posting describes how a “triple whammy” undermined the Triple Aim. It looks at the experience of Dartmouth-Hitchcock Health, the pre-eminent academic health system in northern New England, which recently decided to bail out of  being a Pioneer Medicare Accountable Care Organization.

The “Triple Whammy” discussed in the piece include:

A Flawed Risk-Adjustment Methodology

A Moving And Flawed Target

Identical Incentives Regardless Of Baseline Performance

The authors concluded:

“DH {Dartmouth-Hitchcock} did not make the decision to leave the Pioneer program lightly. A leader in the adoption and application of ACO principles, DH is committed to pursuing high-value population-based care through continuous quality improvement and a relentless focus on cutting waste from health care delivery by engaging providers and payers, waste that is perhaps more difficult to identify and reduce from within a very low-cost environment.”

“To meet its ambitious goals, CMS must provide fair incentives that are large enough to encourage more healthcare systems to enter new reimbursement models and attract and retain providers in both high- and low-cost settings; otherwise, unrestrained fee-for-service cost growth will continue and the full promise of “accountable care” will remain unrealized.

“CMS must rectify the flaws in the Pioneer model so that high-cost ACOs are rewarded for meaningful improvement, and low-cost ACOs—that have already benefited CMS and Medicare beneficiaries by applying ACO principals over the long term and whose ability to generate cost savings is likely to be modest—are rewarded and not punished while demonstrating improvement.”

 

 

 


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