Tell Me If You Heard This One Before?

Many states have the idea that ACOs (accountable care organizations) can hold down Medicaid spending.  This from Kaiser Health News:

To ease that financial strain, Minnesota is at the forefront of a growing number of states testing a Medicaid payment system. It rewards hospitals and physician groups holding down costs by keeping enrollees healthy.

Under this arrangement, those health care providers are asked to do more than just treat medical issues such as diabetes and heart disease. They are called on to address the underlying social issues — such as homelessness, lack of transportation and poor nutrition — that can cause and exacerbate health problems.

Wow, that seems novel and reasonable.  Why not have doctors and hospitals get rewarded for NOT spending too much? Nothing can go wrong with that. And why not have the family doctor be responsible for homelessness or lack of transportation?  I have always said that family docs should adopt more homeless people or at the very least, pick them up and drive them to their appointments. This all sounds like a great plan except, of course, there is the fact that it doesn’t work and ACOs lose money.

Here is a section from the end of the article:

The ACO model has raised concerns among managed-care companies that Minnesota and other states have used for decades to control Medicaid spending. Those companies get a monthly fee from Medicaid for each enrollee and often require those patients to seek care with doctors and hospitals that have contracts with the managed-care firm. The companies profit if they spend less on care than they receive in the state allotment.

“We are aligned with the goals … to explore innovation and provide better delivery of care,” said Scott Keefer, vice president of Minnesota Blue Cross and Blue Shield of Minnesota, which has 300,000 Medicaid members. But, he added, much of the ACO savings cited by state officials are dollars taken from managed-care company profits.

His health plan lost more than $200 million from Medicaid operations during the past two years, partly because it had to pay part of its state funding to ACOs.

“We are not magically saving money. … We are moving the financial deck chairs around,” he said.

I actually find it humorous when you compare the optimism of how this article starts to this last section I highlighted.  It’s like a terrible fable:

“Once upon a time there was a beautiful princess and then she died. The end.”

How is it possible that this ACO concept still survives?  And how is it that the AAFP still is in love with ACOs?  Just Google AAFP and ACO and see how intertwined they are.

I don’t know the answers.  I can tell you that without skin in the game then these patients have no reward for staying healthy or out of the ER.

I have heard the concept of giving Medicaid patients preloaded cards (like for food stamps or EBT cards) to use for monthly payments to their DPC doctors.  I like it and would love to see how much money could be saved WITHOUT making these DPC docs hand over metrics because they would not do that. Heresy you say?  No more than trying this ACO trick over and over.

I think it is worth a try.  I think anything else is worth a try.

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