A so-called exclusive ACO would allow providers, particularly primary care physicians, to join just one ACO. However, FTC regulators said antitrust law recognizes competitive advantages for both exclusive and non-exclusive organizations. On the one hand, they said, providers in an exclusive ACO may be more efficient because they know the organization’s processes. On the other hand, allowing physicians to be in more than one organization may encourage development of more ACOs and thus enhance competition.
Stakeholders speaking in a panel discussion had a wide range of opinions. Advisory letters of the FTC have put too high a value on non-exclusivity, said Lawrence Casalino, MD, chief of the Division of Outcomes and Effectiveness at Weill-Cornell Medical College. In the 1990s, he recalled, his medical group was part of four IPAs. “None of the IPAs had our loyalty,” he said.
Gloria Austin, CEO of Brown & Tolland Medical Group, said she leans to an exclusive model because it allows for a better infrastructure, capital and agreement on methodologies. Non-exclusive arrangements confuse members and physicians, she said.
However, Lee Sacks, MD, president of Advocate Physician Partners, said his group, which includes independent as well employed physicians, has been non-exclusive. “It would be incredibly disruptive to be exclusive today,” he said.
Others favored a mixture of exclusivity and non-exclusivity, depending on the type of provider. The Alternative QUALITY Contract, an kind of private-payor ACO run by Blue Cross Blue Shield of Massachusetts, requires primary care physicians to be exclusive, but hospitals can’t be exclusive and specialists are somewhere in between, said Dana Gelb Safran, senior vice president for performance measurement and improvement at the company.
In a follow-up, FTC officials asked if payors might cover just certain services at a hospital and not others, such as a neonatal unit that is not thought to be high-quality. Elizabeth Gilbertson, president of the Hotel Employees and Restaurant Employees International Union Welfare Fund, said yes, that can occur.
