Dr Joe Antos Explains Challenges of Alternative Payment Models

The future of accountable care organizations (ACO) is very much undefined, as an ACO right now isn’t working to its full potential. However, Joe Antos, PhD, the Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American, is positive that the healthcare system will get there in the coming years.

Transcript (slightly modified)

With Medicare shifting to alternative payment models, but fee-for-service still very much alive, how do payers and providers reconcile these 2 payment models?

Well, alternative payment models are primarily in the eye of the beholder. Certainly, we know what an ACO is because ACOs have been around now for several years. What we don’t know is what will an ACO be in the next few years. Under the next administration, again Democrat or Republican, I see some changes in the way it’s operated to make it a much more effective and practical program. I think that’s good.

Bundled payment — that’s another form of alternative payment model but in fact, there’s really only one bundled payment project now going. It’s for hip and knee replacement and in fact, it’s very, very difficult to construct sensible bundled payments for really almost anything. It’s very, very difficult. So I don’t see bundled payments going very far but I think a lot of work will be put into them.

In the end, I don’t think that’s where we’re going to go. Instead, we need more organized systems of delivery. That’s what ACO’s are supposed to be. Although, I think they fall short of that. That’s what Medicare Advantage plans are supposed to be — they fall short of that as well. The traditional Medicare program doesn’t pretend that it’s an organized system of care but we’re going to get there.