10 of the Most Memorable Quotes About ACOs

Last week, the first-year results of accountable care organizations in the Medicare Shared Savings Program brought on reactions that were — you guessed it — mixed.

This event was one-for-one with ACOs' track record thus far. The model is relatively young in the grand scheme of healthcare, but it has managed to stir up plenty of debate. Some thought leaders see ACOs as a great source of hope, whereas others see the model as nothing but a revamped HMO.

Despite the lack of overall agreement, ACOs have popped up throughout the country since 2010. The total number — both Medicare and commercial ACOs — stands at roughly 606. (Credit for the figure and image goes to Leavitt Partners Center for Accountable Care Intelligence.)

To review ACOs' evolution not only in size and number, here are a few of the most colorful and memorable quotes about the model from roughly 2010 to more recent times. Many of these are from healthcare's thought leaders, who laid out questions, praises, criticism or forecasts about the model. Please note the month and year of each quote, as individuals' thoughts or opinions may or may not have evolved since that time.

Thoughts are expressed in chronological order.  

1. "In the early 20th century, the healthcare system changed dramatically with the introduction of antisepsis and the increasing safety and success of surgery: hospitals gained power as they became associated with hope and health rather than fear and death. Now, after decades of hospital hegemony, we stand at another crossroads; physicians may be able to gain market leadership if they move first. How the development of ACOs plays out over the next few years is likely to have lasting implications for the practice of medicine, patients' experience of health care, and health care costs in the United States."

—— Robert Kocher, MD, former special assistant to the president for healthcare and economic policy, and Nikhil R. Sahni, fellow at the Forum for Growth and Innovation at Harvard Business School
From "Physicians versus Hospitals as Leaders of Accountable Care Organizations" via The New England Journal of Medicine (December 2010)

2. "ACO has become the three-letter health acronym of the year, if not the decade."

—— Steve Lieberman, a visiting scholar at the Engelberg Center for Health Care Reform at the Brookings Institution and the president of Lieberman Consulting  
From "Accountable Care Organizations, Explained" via NPR (January 2011)

3. "An observation: In 1995, you may have found yourself cursing out HMOs at the office water cooler. But unless you work in healthcare, in 2011 you probably aren't discussing ACOs at the workplace Keurig. And that is sort of the point. Policy makers are seeking to do what HMOs promised to do (slow the growth of health care costs) without infuriating patients. "

—— Zachary Meisel, MD, assistant professor of emergency medicine at the University of Pennsylvania and TIME columnist, and Jesse Pines, MD, professor of emergency medicine and health policy at George Washington University
From "Post-HMO Health Care: Are ACOs the Answer?" via TIME (May 2011)

4. "'Accountable care organizations' is jargon for the radical concept that when doctors and nurses actually talk to each other about shared patients, there will be fewer mix-ups, less duplication and patients will receive better, more convenient care at a lower cost. Markets created the first ACOs, including Kaiser Permanente, more than six decades ago. The federal government, in contrast, has long tried to ensure that nothing so sensible ever happens."

—— Michael F. Cannon, director of health policy studies at the Cato Institute
From opinion column "ACO Debacle Exposes Obamacare's Fatal Conceit" via Kaiser Health News (June 2011)

5. "Against the very meager prospects for cost savings, there is a very real risk that some ACOs will be formed with an eye toward creating or exercising market power. The net result of the [Medicare] Shared Savings Program may therefore be higher costs and lower quality healthcare — precisely the opposite of its goal."

—— J. Thomas Rosch, former commissioner of the Federal Trade Commission
From his speech, "Accountable Care Organizations: What Exactly Are We Getting?" (November 2011)

6. "Given the uneven track record of managed care and Medicare Advantage, it is hard to fault experts when they seem gloomy about the prospects for ACOs. But ACOs are neither Medicare Advantage redux nor a reprise of the Physicians' Group Practice demonstration. Lessons from the PGP sites — which improved quality but did much less for costs — did inform the ACO design. But the ACO program differs from PGP in the terms for gain sharing, quality metrics, governance requirements, information systems and more."  

—— Donald Berwick, MD, former acting CMS administrator
From "Can Accountable-Care Organizations Improve Health Care While Reducing Costs?" via The Wall Street Journal (January 2012)

7. "The ACOs are in effect latter-day health-maintenance organizations — doctors, hospitals and other health-care providers grouped together to provide coordinated care. … We believe that many of them will not succeed. The ACO concept is based on assumptions about personal and economic behavior — by doctors, patients and others — that aren't realistic."

—— Clayton Christensen, professor of business administration at Harvard Business School and co-founder of Innosight Institute, Jeffrey Flier, dean of the faculty of medicine at Harvard University and professor of medicine at Harvard Medical School, and Vineeta Vijayaraghavan, senior research fellow at Innosight Institute
From "The Coming Failure of 'Accountable Care'" via The Wall Street Journal (February 2013)

8. "All of care is going to move down this path [value-based care], and it has to. Medical homes are doing it; the very best ACOs are going to figure out how to do it."

—— George Halvorson, former CEO and current chairman of Oakland, Calif.-based Kaiser Permanente.
From "The Face of Future Health Care" via The New York Times (March 2013)

9. "At the end of the day, if the only successful ACOs are those from Geisinger, [Rochester, Minn.-based] Mayo Clinic and Kaiser Permanente, what has society gained? These organizations were already operating at the highest levels of confidence in respect to the triple aim."

—— Marc Bard, MD, author of "Accountable Care Organizations: Your Guide to Strategy, Design and Implementation"
From "ACOs: The Least Agreed-Upon Concept in Healthcare?" via Becker's Hospital Review (May 2013)

10. "Evaluations of recent ACO programs show quality improvements among all participating organizations and financial savings for many. This is not a surprise. The Institute of Medicine has been reporting for more than a decade that a third or more of medical spending could be eliminated while increasing patient health. The only surprise is how fast the system has moved in this direction."

—— David Cutler, PhD, professor of economics at Harvard University and senior healthcare adviser to President Barack Obama's 2008 presidential campaign
From "The Health-Care Law's Success Story: Slowing Down Medical Costs" via The Washington Post (November 2013)

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