June 6, 2012

Why Accountable Care Organizations Are Not 1990s Managed Care Redux

Author Affiliations

Author Affiliations: Office of the Provost and Department of Medical Ethics and Health Policy, Perelman School of Medicine and Wharton School, University of Pennsylvania, Philadelphia.

JAMA. 2012;307(21):2263-2264. doi:10.1001/jama.2012.4313

Many people are concerned that accountable care organizations (ACOs) and other delivery system reforms in the Affordable Care Act will simply bring back the managed care days of the 1990s. These skeptics suspect that payment reforms to control high and increasing costs will simply lead to gate keeping and service denial rather than the promise of care redesign and coordination that removes unnecessary cost and delivers better outcomes.

Managed care alienated many physicians by excluding many of them from networks, intensely bargaining on payments, empowering primary care physicians as gatekeepers, and requiring prior authorizations for many tests and treatments. Physicians in turn denigrated managed care, often blaming managed care companies for prohibiting them from providing services they thought were necessary.

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