Abstract: Physician-to-physician referrals play a central role in the health care systems and are drives of costs and quality. There is evidence that referrals are currently misused and overused and recognition that they will have to change if health reform objectives such as care coordination and cost reduction are to be achieved (Son et al., 2014). Indeed, many of the models of care supported by the Affordable Care Act (e.g., accountable care organizations (ACOs), patient-centered medical homes, bundled payments) depend on physicians making high-value referrals.
The Affordable Care Act has generated carrots and sticks for hospitals to reduce readmissions. With the goal of achieving the Triple Aim (improving quality of patient care, improving population health, and reducing overall cost of care), innovative care delivery models are being tested locally and nationally, including the roll-out of Accountable Care Organizations and bundled payment programs. These programs create incentives in terms of shared savings for health care systems that provide high quality, coordinated care.
A few months ago, I spoke with LDI Senior Fellow Lawton R.
The news from the latest ACO study in JAMA seemed good; not only could ACOs save money in commercially insured patients in Massachusetts, the savings were "contagious," spreading to non-ACO Medicare patients seen by the same providers.
This Issue Brief summarizes the similarities and differences between the new ACOs and the integrated delivery networks of the 1990s, and presents the authors’ analysis of the likely success of these new organizations in affecting the costs and quality of health care.