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Lead Moderator

Good morning, all! I'm going to pick up on one of the concepts Dr Sage mentioned yesterday. Today I'd like to talk about ACOs, which were one of the major delivery system reforms in the ACA. There are now hundreds of ACOs and a variety of models that prospective applicants can choose from.

The basic goal of ACOs is to create incentives (and a legal safe harbor) for collaboration to lower spending and improve quality for a cohort of patients. If an ACO saves money relative to projected cost trends, conditional on meeting quality benchmarks, a portion of the savings are returned to the ACO. The idea is to relax the constraints of fee-for-service and encourage and reward efficiency. To date, the effect of ACOs has been less radical than we might have hoped -- with estimated savings under 2% and similarly modest effects on quality. On the bright side, however, it seems that ACOs improve their performance over time.

Have any of you had experience working in ACOs? What has that been like? What do you make of ACOs as they currently exist? Do you have recommendations for how to improve? Do you think we should go in another direction entirely?