Hi Sue Thank you for your kind words about the videos and bringing this to my attention. We wrote about this about 2 years ago when some of the groups with whom we participate identified it as a serious issue, as you rightly do. Those groups included Physicians for a National Health Plan and the League of Women Voters Healthcare Special Interest Group (national).
I promise to bring myself back up to date on ACOs and write about them as well as have actions that we can all take to make sure our representatives know the score.
I really appreciate you also including links to make my job easier. Again, thank you.
Alan Unell: I have just recently started watching your YouTube channel and I am so impressed with the amount of hard work you put into the research of your topics. There is a topic that I would like you to investigate that no one else is talking about but is very serious and can do a lot of damage to Medicare health care beneficiaries. The subject is Accountable Care Organizations. This is a complex subject and there is a lot that goes into it that even I, who has tried to understand it for years, still do not know a tenth of it.
Back in 2010, President Obama started the Affordable Care Act. Part of the policy is to enroll all traditional Medicare beneficiaries into Accountable Care Organizations (ACO) by the year 2030. ACO will act like Advantage plans in that the beneficiary will be required to have a primary care provider which can be an MD, OD, PA or RNP, who will act as their guardian (gatekeeper). This gatekeeper, regardless of their education or experience, will be in charge of managing, coordinating and controlling their health care (like HMOs/Advantage plans). The gatekeeper, and their health plan organization, will be held responsible for total cost of care (capitated payment) in exchange for total care (HMO style). This gatekeeper will decide if, when, where and when you will see a specialist (unless the beneficiary knows their rights and insists on seeing the specialist of their choice). If allowed to see a specialist, the gatekeeper will "steer" the beneficiary to one of their own specialist or a specialist that they have partnered with in the community. This specialist has agreed to low-cost (often low quality) care inasmuch as they are partnered with an ACO who is responsible for the total cost of care. Traditional beneficiaries will have no idea that they are in highly controlled, managed value-based (HMO) care as they are not being told and if they are told, they are told in a way that they do no understand the ramifications of being in such a situation. The most that is required of an ACO to inform patients is to tack a notice in the waiting room, knowing that no one is going to read it. As well, Medicare beneficiaries will be undergoing step therapy, prior authorizations, delayed and denied care, just like in HMO's and Advantage plans (that is how capitated systems work).
Even worse, ex-president Trump allowed private equity investment firms to start ACOs (what could go wrong with that), again without the patient knowing about the dire consequences. This ACO model is called ACO-REACH. President Biden had the opportunity to stop the project but did not. ACO providers are required to jump through all kinds of CMS hoops, required blood tests, required medications, step therapy, required immunizations. The requirements are so strict, the providers have very little concern for patient safety or autotomy, as the provider's first and foremost responsibility is to satisfy CMS (not what the beneficiary wants). If the patient asserts their patient rights and it disagrees with what CMS wants (like denying statin therapy or a Covid for flu shot), they are labelled "noncompliant" in their electronic health record, as if they were nothing but a naughty little child. The more hoops the providers jump through correctly, the more money they or the health care system makes. Therefore, they are literally punished if they do not follow CMS's guidelines. I have even heard of doctors "firing" patients for not following their (actually CMS's) orders, as in not taking their statin or anti-hypertensive medication.
The last article I read recently was that CMS has been able to railroad 50% of traditional beneficiaries into a managed-care, value-based ACO. ACO's include Johns Hopkins, Mass General, Mayo Clinics, Stanford, UC California systems, Dignity Health, Sutter Health, Cleveland Clinic. Right now, most of these ACO's are hybrid models, partial fee-for-service and partial Medicare subsidized with bonuses, the more money saved, the higher the bonus payments.
Not only that, CMS has been experimenting on traditional beneficiaries with "bundled payments" as in, a capitated payment for bundled services such as a capitated payment for total cost of care for a heart attack, stroke, orthopedic procedures and even one's oncology care (Google CMS Innovation Oncology Model." How would you like it if you found out that you had life-threatening cancer and CMS paid an oncology clinic (who agreed to give cut-rate care) a flat fee to treat you. I think it is a five-year study before they determine if it is a "success" or not....and the patient is not being told that they are in such a capitated payment system. They are not going to be told that they could go to MD Anderson, Stanford, UCLA, Mayo, Cleveland, etc. because they know no one would agree to such a thing if they were given a choice.
So, Dr. Unell, if you have ever been in an highly controlled, high regulated, parsimonious, restrictive, dangerous HMO or Advantage plan, then you would understand the necessity of spreading the word to all Medicare beneficiaries as they have absolutely no idea they are in one. It angers me to no end how deceptive and devious CMS is about this set up. Not understanding that one is in a HMO style health care when one thinks they have free choice, could cost people their lives.
Link to the CMS Innovation Center (ACO) white paper
"Advanced primary care and accountable care models are central to driving growth in the number of beneficiaries in accountable care relationships. The CMS Innovation Center has set the goal of having every Medicare FFS beneficiary in an accountable care relationship by 2030 and will set interim targets to measure progress towards that goal. This goal would not only aim to have all beneficiaries in value-based care arrangements, but for them to be in care arrangements where their needs are holistically assessed and their care is coordinated within a broader total cost of care system."
This is an old article from the "Independent Institute" but what he says is still relevant today.
Thank you, Dr. Unell. This is so evil and so dangerous and no one knows about it. Would you please help get the word out (that is, if you disagree with ACOs, maybe you are in favor of them).
Hi Sue Thank you for your kind words about the videos and bringing this to my attention. We wrote about this about 2 years ago when some of the groups with whom we participate identified it as a serious issue, as you rightly do. Those groups included Physicians for a National Health Plan and the League of Women Voters Healthcare Special Interest Group (national).
I promise to bring myself back up to date on ACOs and write about them as well as have actions that we can all take to make sure our representatives know the score.
I really appreciate you also including links to make my job easier. Again, thank you.
Alan Unell: I have just recently started watching your YouTube channel and I am so impressed with the amount of hard work you put into the research of your topics. There is a topic that I would like you to investigate that no one else is talking about but is very serious and can do a lot of damage to Medicare health care beneficiaries. The subject is Accountable Care Organizations. This is a complex subject and there is a lot that goes into it that even I, who has tried to understand it for years, still do not know a tenth of it.
Back in 2010, President Obama started the Affordable Care Act. Part of the policy is to enroll all traditional Medicare beneficiaries into Accountable Care Organizations (ACO) by the year 2030. ACO will act like Advantage plans in that the beneficiary will be required to have a primary care provider which can be an MD, OD, PA or RNP, who will act as their guardian (gatekeeper). This gatekeeper, regardless of their education or experience, will be in charge of managing, coordinating and controlling their health care (like HMOs/Advantage plans). The gatekeeper, and their health plan organization, will be held responsible for total cost of care (capitated payment) in exchange for total care (HMO style). This gatekeeper will decide if, when, where and when you will see a specialist (unless the beneficiary knows their rights and insists on seeing the specialist of their choice). If allowed to see a specialist, the gatekeeper will "steer" the beneficiary to one of their own specialist or a specialist that they have partnered with in the community. This specialist has agreed to low-cost (often low quality) care inasmuch as they are partnered with an ACO who is responsible for the total cost of care. Traditional beneficiaries will have no idea that they are in highly controlled, managed value-based (HMO) care as they are not being told and if they are told, they are told in a way that they do no understand the ramifications of being in such a situation. The most that is required of an ACO to inform patients is to tack a notice in the waiting room, knowing that no one is going to read it. As well, Medicare beneficiaries will be undergoing step therapy, prior authorizations, delayed and denied care, just like in HMO's and Advantage plans (that is how capitated systems work).
Even worse, ex-president Trump allowed private equity investment firms to start ACOs (what could go wrong with that), again without the patient knowing about the dire consequences. This ACO model is called ACO-REACH. President Biden had the opportunity to stop the project but did not. ACO providers are required to jump through all kinds of CMS hoops, required blood tests, required medications, step therapy, required immunizations. The requirements are so strict, the providers have very little concern for patient safety or autotomy, as the provider's first and foremost responsibility is to satisfy CMS (not what the beneficiary wants). If the patient asserts their patient rights and it disagrees with what CMS wants (like denying statin therapy or a Covid for flu shot), they are labelled "noncompliant" in their electronic health record, as if they were nothing but a naughty little child. The more hoops the providers jump through correctly, the more money they or the health care system makes. Therefore, they are literally punished if they do not follow CMS's guidelines. I have even heard of doctors "firing" patients for not following their (actually CMS's) orders, as in not taking their statin or anti-hypertensive medication.
The last article I read recently was that CMS has been able to railroad 50% of traditional beneficiaries into a managed-care, value-based ACO. ACO's include Johns Hopkins, Mass General, Mayo Clinics, Stanford, UC California systems, Dignity Health, Sutter Health, Cleveland Clinic. Right now, most of these ACO's are hybrid models, partial fee-for-service and partial Medicare subsidized with bonuses, the more money saved, the higher the bonus payments.
Not only that, CMS has been experimenting on traditional beneficiaries with "bundled payments" as in, a capitated payment for bundled services such as a capitated payment for total cost of care for a heart attack, stroke, orthopedic procedures and even one's oncology care (Google CMS Innovation Oncology Model." How would you like it if you found out that you had life-threatening cancer and CMS paid an oncology clinic (who agreed to give cut-rate care) a flat fee to treat you. I think it is a five-year study before they determine if it is a "success" or not....and the patient is not being told that they are in such a capitated payment system. They are not going to be told that they could go to MD Anderson, Stanford, UCLA, Mayo, Cleveland, etc. because they know no one would agree to such a thing if they were given a choice.
So, Dr. Unell, if you have ever been in an highly controlled, high regulated, parsimonious, restrictive, dangerous HMO or Advantage plan, then you would understand the necessity of spreading the word to all Medicare beneficiaries as they have absolutely no idea they are in one. It angers me to no end how deceptive and devious CMS is about this set up. Not understanding that one is in a HMO style health care when one thinks they have free choice, could cost people their lives.
Link to the CMS Innovation Center (ACO) white paper
https://www.cms.gov/priorities/innovation/strategic-direction-whitepaper
Page 14:
"Advanced primary care and accountable care models are central to driving growth in the number of beneficiaries in accountable care relationships. The CMS Innovation Center has set the goal of having every Medicare FFS beneficiary in an accountable care relationship by 2030 and will set interim targets to measure progress towards that goal. This goal would not only aim to have all beneficiaries in value-based care arrangements, but for them to be in care arrangements where their needs are holistically assessed and their care is coordinated within a broader total cost of care system."
This is an old article from the "Independent Institute" but what he says is still relevant today.
https://www.independent.org/news/article.asp?id=3372
Thank you, Dr. Unell. This is so evil and so dangerous and no one knows about it. Would you please help get the word out (that is, if you disagree with ACOs, maybe you are in favor of them).
Sue Milbourne