Hospital chain, insurer form big accountable care organization [Fort Worth Star-Telegram]
|By Jim Fuquay, Fort Worth Star-Telegram|
|McClatchy-Tribune Information Services|
ACOs, a part of the federal Affordable Care Act, are groups of medical providers and related companies that together work to save money while improving patient health. They were originally designed to apply to the federal
However, commercial ACOs like the THR-Blue Cross effort also exist, usually with participants who have health insurance through an employer.
THR has 25 area hospitals and says it admits more patients annually than any other hospital system in
Commercial ACOs resemble managed-care organizations of the 1990s that aimed to control costs by requiring doctors and hospitals to share in the risk of rising medical costs. Those "capitated" models -- so named because they put a per capita budget on spending -- quickly faded as consumers and physicians found them too restrictive, regulators trimmed their powers, and savings failed to materialize.
Sanchez said all parties are now much more committed to sharing data. Physicians, hospitals and other medical providers "have not been connected electronically to the degree we will be for the near-real-time exchange of information," Sanchez said.
He said the improved data will also allow it to more accurately predict medical costs for patients, whether young or old.
"The reimbursement model is much more sophisticated" in adjusting for risk, he said. "That's very different than 15 or 20 years ago."
Long said the new ACO also differs from a capitated plan because THR does not fully share in the risk of higher medical costs, although the precise details are still being developed. Instead, the ultimate financial risk stays with
He said THR will approach other insurers to create similar ACOs with them.
All ACOs, whether
The ACO covers 12
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