Call for Papers for a Special Issue of the Journal of Management and Health Care: Innovation in Health Care Delivery: The Promise and Challenges of Accountable Care Organisations
Stephen S. Mick, Ph.D., FACHE, Professor, Department of Health Administration, Virginia Commonwealth University
Jean-Pierre Claveranne, Professor, IFROSS, Jean Moulin University Lyon 3, France
Christophe Pascal, Associate Professor, IFROSS, Jean Moulin University Lyon 3, France
Almost unnoticed in the swirling public controversy in the United States over the Patient Protection and Affordable Care Act (PPACA) of 2010 (sometimes called « ObamaCare »), whose primary objective is to reduce the number of uninsured persons, are certain provisions in the law that call for innovation in the delivery of care. In particular, organizational restructuring of patient care is called for, and the idea is packaged in the generic term of accountable care organizations (ACOs).
These organizational forms are supposed to combine provider payment and delivery system reforms. The payment reform aspect would consist of performance-based reimbursement approaches and possibly bundled payments as well as shared payer-provider risk models, which combine hospital and physician reimbursement. The organizational reform aspect would allow for a flexible melding together of various delivery components depending on local market circumstances so long as three preconditions are met : 1) the provision of a continuum of care that includes at least ambulatory and inpatient care, and possibly post acute care services ; 2) the capacity to develop, implement, and monitor prospectively planned budgets ; and, 3) sufficient size to be able to report comprehensive, valid, and reliable performance measurement across a wide variety of organizational and clinical activities. Taken together, ACOs are supposed to increase access to care across populations, care that is not only of high quality but also cost-effective.
The ACO portion of the PPACA is voluntary, but by mid-2012, some 300 organizational entities had responded positively to the incentives and requirements posed by the ACO component of the Act, and it appears that there is no singular organizational form that dominates those entities that have responded. In fact, advocates of the ACO have themselves proposed widely varying organizational arrangements as possible ACO participants, with arrangements covering a spectrum of highly decentralized contractual arrangements to more organizationally centralized systems such as a staff or group model HMO. As yet, there is no discernable trend for various dimensions of performance for ACOs generally.
Too often reform efforts in a given country, in this case the United States, are assessed as if they are unique to the country in which they take place. The mistake is to assume that there are no lessons to be learned from other countries that may have attempted similar reforms. In fact, the American ACO reform presents similarities to initiatives undertaken in several European nations, notably France, which consist of changes in payment policies. A global payment covering the entirety of a patient care episode combined with a performance aspect is to be substituted for traditional fee for service payment.
With this background, questions that the proposed issue of the Journal are interested in exploring include :
- Will ACOs realize such lofty potential and truly have an impact in the long run?
- Will there be a correlation between certain types, forms, or structures of ACOs and desired performance?
- Will this reform effort contribute to « bending the cost curve? »
- Will innovative payment and service models be enthusiastically embraced by patients and providers, or will they be viewed as « new wine in old bottles » of managed care and integrated delivery systems?
- Will diverse stakeholders set aside their focused, competing interests and collaboratively work to support meaningful health care reform, particularly in the midst of a contentious and hyper-partisan political environment?
- Are there lessons from outside the United States that can inform discussion and research on the likelihood of ACO performance?
The singular sentiment resulting from these many questions is that much uncertainty remains for the future of the U.S. health care system as it anticipates the effects – both intended and unintended – of the ACO movement.
Calendar for Call for Papers
Receipt of the proposed articles : June 16, 2014
Selection of articles and notification to authors : July 2, 2014
Receipt of final drafts : September 1, 2014
Publication : Fall 2014