The administration has been pushing very hard on the Accountable Care Organization (ACO) model, which is a somewhat nebulous concept, but which is broadly supposed to save money by streamlining services and coordinating care. It's one of the centerpieces that pro-Obamacare wonks point to as a real source of cost savings and improved services. Exhibits A and B are usually Mayo and the Cleveland Clinic, with a few others occasionally thrown in.
During the health care debate, the Mayo Clinic, the Cleveland Clinic, Geisinger Health System and Intermountain Healthcare were repeatedly touted as models for a new health care delivery system.
Now, they have something else in common: All four have declined to apply for the "Pioneer" program tailor-made by the Obama administration to reward such organizations.
"When the poster boys ask that the posters be taken down, you have a problem," says Michael Millenson, president of Health Quality Advisors LLC. The lack of participation, he says, suggests that "somebody messed up": either the government didn't make the rules appealing enough, or "when push came to shove, the big players didn't want to play by the rules."
The four health systems are considered the most promising models for "accountable care organizations," a new approach to delivering health care services that rewards doctors and hospitals for providing high-quality care to Medicare beneficiaries while keeping costs down. The ACO provision became one of the most highly anticipated elements of the health care overhaul, and providers embarked on a frenzied race to join in as quickly as possible.
ACOs--or at least some of the features that the administration envisions--may well be the future of Medicare, for all I know. But it was always folly to point to places like the Mayo Clinic as an example of what was possible for national health care reform.
This article available online at: