Accountable care will make patients more responsible

HMOs are so 20^th century.  Doctors – and, like it or not, their patients – are now being moved into “accountable care organizations,” or ACOs.  The result is likely to be less health care dispensed to, and more responsibility placed on patients for self-care, especially for older folks.

Created by the Affordable Care Act, an ACO is a group of medical care providers, usually heavy on primary care physicians, that contracts to provide care to a specific population, such as the employees of a corporation or the population of Medicare members in the ACO’s member rolls.  The payer – a corporation or the federal government, in these examples – allots the ACO a fixed amount of money to care for all the medical needs of the population for a specified period of time.  If the cost of care for the group doesn’t use up the allotment, the physicians keep the savings.  If costs exceed the allotted amount, the ACO’s doctors eat the loss.

This incentivizes doctors to desist from running unnecessary tests to inflate their bill to insurance companies.  Instead, the ACO physician has powerful reasons to keep you from needing his services in the first place – to make it their business to see that you lose weight, hit the gym or yoga studio regularly, and otherwise ensure that you need as little medical care as possible.  Clearly, ACOs have been designed to blunt the relentless growth in health care costs.

Up and running in more than 30 states, ACOs are predicted to spread nationwide before 2018.