Adopting Accountable Care Through the Medicare Framework

Abstract:     
The Patient Protection and Affordable Care Act of 2010 (PPACA) attempts to provoke change in the status quo in American health care delivery and payment. PPACA created two programs, the Medicare Shared Savings Program (MSSP) and the Pioneer ACO model, which work to bring the concept of Accountable Care Organizations (ACOs) to the Medicare program. At its core, accountable care matches payment for care with performance-based measures, a bold move away from current volume-based models. The paper makes the case that the Medicare-based programs serve as a suitable launch pad for the accountable care movement. The paper explores the emergence of accountable care in two states, Wisconsin and New Jersey, with very different health care markets. The contrasting stories offer insights into the flexibility of the criteria of MSSP so that all states may adopt ACO models regardless of their political or commercial environments. The paper demonstrates how MSSP creates an innovative framework to implement ACOs that responds to skeptics. The frame work includes patient-centered criteria, a legal roadmap to reduce market abuses, and a multi-tiered governance structure. The patient engagement requirements respond to the previous history of managed care and consumerism. The legal roadmap includes safety zones to address antitrust and other market abuses. Multi-tier governance diffuses the ACO concept throughout the nation through vertical and horizontal dimensions. The paper concludes with a discussion of how the MSSP framework is impacting collaborative efforts in the Wisconsin and New Jersey markets.

Number of Pages in PDF File: 51

Keywords: Health Regulation Goverance

JEL Classification: K2

Accepted Paper Series