Proponents of the ACO model argue that this time it’s different, that the model is not about controlling physicians, it’s about clinical issues and getting physicians integrated with other providers, both in respect of macro issues (e.g., establishing protocols, determining best practices and the design of studies) and micro issues (e.g., the coordination of a particular patient’s care).
But that argument entails a large dose of revisionist history: The proponents of prior movements to manage physician behavior, for example, managed care and integration models such as the PHO, did not sell their wares, at least publicly, as such – they, too, touted their models as being for the betterment of patient care.
“Managed care” was said to be about managing how care is delivered across multiple providers. HMOs were said to deliver better and more efficient care because they were premised on maintaining health, not waiting to treat disease. And PHOs were all about aligning the incentives of physicians and hospitals such that better care was delivered more efficiently.
The truth is that this time it is different, but in a very different way than ACO proponents would have you believe. Over the decades since the beginning of the managed care movement, the microchip revolution has made it even more possible for disparate participants to coordinate care in the absence of any actual command and control authority. The changes made possible through advances in technology are democratizing and an assault on those who want to control from the top down.
Viewed in the light of technology, and the fact that its progress will continue at an even faster pace, the ACO model as viewed by its hospital-centric proponents is a reactionary step, a gasping grasp by those wishing to impose control over physicians, control which is not needed in terms of the actual coordination of care.
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Mark F. Weiss