The Year of the ACO

officials at the Centers for Medicare and Medicaid Services (CMS) have issued a request for comments on some of the themes that emerged from that workshop.

"Physician panelists at that workshop were concerned that hospitals were the ones with the resources to put together the electronic records and other infrastructure to start and operate an ACO," Mills says in a commentary on the workshop. "They feared that all physicians would wind up employed by hospitals and physicians would not take a lead role in reforming health care delivery."

Health insurers and health care buyers also expressed concerns about hospitals' role in ACOs, Mills says.

Insurers and buyers fear hospital-led ACOs may not offer buyers competitive choices.

"Many panelists were concerned that 'patient-centeredness' was being downplayed," Mills says.

In the CMS request for comments, officials are focusing on how to encourage solo practitioners and small groups to participate in ACOs, and how the patient centeredness of ACOs and patients' experience of ACO care can be measured, Mills says.

Aetna Inc., Hartford (NYSE:AET), says an ACO it has been testing on 20,000 Medicare Advantage enrollees since 2007 seems to be working well.

The ACO program provides personalized care management and support; technology that connects doctors with patient information and medical evidence; and financial incentives that reward doctors who work hard to provide good care for patients with chronic conditions and doctors whose patients' health improves.

This year, the ACO enrollees have been using 43% less acute hospital care than comparable enrollees in unmanaged Medicare have been using, Aetna says.