Issue link: https://beckershealthcare.uberflip.com/i/221514
Clinical Integration & ACOs 24 He says his health system didn't seek out or plan for the uptick in members choosing Saint Thomas Health; it's just a side effect. He also anticipates the local market becoming even more competitive as healthcare reform continues. "I expect there will be at least three ACOs and maybe more in middle Tennessee," he says of the near future. "At some point, when they realize that it's working, the other systems will create them. I see a sort of cowboy period here where new players are entering into the field." However, others see ACOs leading healthcare markets in the opposite direction. In September, various legal experts testified before House lawmakers concerning healthcare consolidation, and some of them expressed concern that the ACOs formed under the Patient Protection and Affordable Care Act could pose a serious danger by giving providers more market power and fueling monopolies. ACOs: A meaningful opportunity for reform or a potential pathway to monopolization? Accountable Care Organizations and Market Share: Could Care Coordination Drive Monopolization? By Helen Adamopoulos A increasingly difficult environment for healthcare providers in the midst of major changes and mounting financial pressures, founded MissionPoint Health Partners, a clinically integrated health network that aims to provide patient-centered, coordinated care while improving quality and lowering costs. After six months of operating as an accountable care organization, MissionPoint joined the Medicare Shared Savings Program. The ACO experienced more than 12 percent savings for the first 15,000 lives it managed, and as of October it had grown to 80,000 mem- bers, according to Saint Thomas CEO Mike Schatzlein, MD. Additionally, Dr. Schatzlein says the ACO has affected Saint Thomas' desirability as a preferred partner in the region. "A MissionPoint member is 15 percent more likely to utilize us than they were before they became a MissionPoint member," he says. "When you are helping someone transition from the hospital, doing a safety check in their home and helping communicate with family members, patients naturally want to return to a facility that provides a best-in-class experience." Hospital and healthcare consolidation has been on the rise lately as providers face mounting pressure to improve quality of care while holding down costs. Healthcare merger and acquisition activity increased by almost 20 percent year-over-year in the third quarter of 2013, with 267 deals announced, according to a report from Irving Levin Associates. Hospital deals went up by 20 percent to 24 deals. This surge in consolidation has raised concerns about hospitals and health systems forming monopolies and using their status to push for higher prices. The highest-priced hospitals within a market often have charges 60 percent higher than the lowest-priced market competitor, and the high-priced hospitals often wield a huge amount of influence, according to a study released this fall by the Center for Studying Health System Change. Heightened merger and acquisition activity led to the House hearing in September. One of the experts who testified before federal lawmakers was Barak Richman, JD, PhD, a healthcare economics, law and policy professor at the Duke University School of Law in Durham, N.C. He devoted a section of his testimony to the "special problem" of ACOs, which he said could be a primary target for revived antitrust scrutiny. The healthcare reform law encourages providers to integrate and form ACOs to improve quality of care and lower costs. These coordinated care efforts could revolutionize healthcare delivery, but they could also have the unintended consequence of giving providers more market share and greater power to drive up prices, according to Dr. Richman.