tag:blogger.com,1999:blog-32053362.post8357905345532012875..comments2024-03-26T00:25:34.026-04:00Comments on Not Running a Hospital: What happened to pairing risks and rewards?Paul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-32053362.post-16680873259605403362014-12-02T11:10:57.029-05:002014-12-02T11:10:57.029-05:00The obvious reason for no downside risk is to keep...The obvious reason for no downside risk is to keep the health systems in a program that was poorly designed. ACOs are auto assigned Medicare membership based on claims showing which doctor a patient went to most frequently so you have these older patients unaware they are even in a risk based program. At least in Medicare Advantage programs members seek out these plans and know the upside and downside (restricted networks). ACO rules state patients can go to any Medicare approved doctor or hospital.... how do you manage cost and control leakage in an ACO where members don't know they are in the risk product and can go anywhere they want without restriction? Add in health systems now bearing risk and dealing with something like the Gilead drug Sovaldi at $83,000 per hepatitis patient and systems are bearing more risk than they can carry and will lose money. Very poorly designed product that was largely political to try and produce something to tame rising costs. As they are learning, it's not as simple as passing capitated risk from the federal government to the health systems. Patients are going to have to give SOMETHING up in terms of access or benefits if you really want to bend the cost curve. Otherwise, the wave of baby boomers getting everything they want medically at whatever doctor or hospital they choose is going to bankrupt Medicare at some point in the not to distant future.Anonymousnoreply@blogger.com