案例库 · 财务与会计 · 财务决策 · 2012-2024
这条还没译成中文，下面是英文原文。
Medicare ACOs let providers keep part of the savings they create.
Accountable care organizations make groups of providers responsible for a whole patient population and let them share the savings if they beat a cost benchmark.
Centers for Medicare & Medicaid Services · U.S. provider groups
那一手
Traditional fee-for-service paid a doctor for each visit, so no one owned the cost or quality of a patient's care across providers.
The Affordable Care Act created accountable care organizations: provider groups that take responsibility for the cost and quality of a defined population, with a benchmark set from historical spending.
In the Shared Savings Program an ACO that delivers care below the benchmark while hitting quality measures keeps a share of the difference, aligning the payment with the patient's whole episode.
为什么管用
- Shared savings rewards keeping costs down rather than generating volume
- Quality gates stop the savings from coming at the expense of care
- Providers coordinate because they are financially joined
- It transplants managed-care incentives onto independent practice
可以搬走什么
If you want providers to manage the whole patient, pay them for the whole patient — set a benchmark and let them share the savings below it.
后来呢
Participation grew each year, and in 2024 about 480 Medicare Shared Savings Program ACOs covered millions of beneficiaries, but results varied and some studies found modest savings, so the model was repeatedly tweaked to push providers to take on more financial risk.
资料来源
- Medicare ACO participation grows in 2024: CMS
- Participation Continues to Grow in CMS' Accountable Care Organization Initiatives in 2024
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