Category Archives: Accountable care organizations

Aug 29 2013

Human Capital News Roundup: Depression and poverty, substance use among SNAP recipients, accountable care organizations, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

The U.S. News & World Report Economic Intelligence blog cites a study co-authored by RWJF Scholars in Health Policy Research alumna M. Marit Rehavi, PhD, that finds mothers who are physicians are 9 percent less likely to have unscheduled C-sections than their non-physician counterparts. The researchers used this and other data to examine the interaction between patient information and financial incentives for physicians, as C-sections are typically more profitable than traditional deliveries.

A low-cost, home-based program called “Beat the Blues” lowers depressive symptoms among older African Americans who are having trouble paying for basic needs, according to a study co-authored by RWJF Nurse Faculty Scholar Sarah Szanton, PhD, CRNP. Szanton’s findings coupled with those in another study that showed meaningful reductions in depressive symptoms from the program “suggest that depression can be 'decoupled’ from financial strain," reports.

Harold Pollack, PhD, MPP, co-authored a post for the Washington Post Wonk blog about research he led that finds adults whose households receive support from the Supplemental Nutrition Assistance Program (SNAP) are only slightly more likely than non-recipients to display substance use disorders. “Proposals to drug-test SNAP recipients don’t address the genuine challenges posed by drug and alcohol misuse in American society,” he writes. “Instead, poor families who seek a little help with the food money are being used as stage extras in a different, nasty ideological fight.” Pollack is an alumnus of the Scholars in Health Policy Research program and recipient of an RWJF Investigator Award in Health Policy Research.

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Apr 30 2013

RWJF Scholar Alum Discusses Accountable Care Organizations

Elliott Fisher, MD, MPH, a health policy researcher and alumnus of the Robert Wood Johnson Foundation Clinical Scholars program (1983-1985), was recently named director of the Dartmouth Institute for Health Policy & Clinical Practice. Fisher coined the term “Accountable Care Organization” (ACO). In this Clinical Scholar Health Policy podcast, he discusses the origins of ACOs and the effort to develop them in the nation’s health care system. Watch his interview with RWJF Clinical Scholar Chileshe Nkonde-Price, MD, (2012-2014). The video is republished with permission from the Leonard Davis Institute.

Mar 22 2013

A ‘Goldilocks’ Theorem of Shared Savings and ACOs

Brendan Saloner, PhD, is a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar in residence at the University of Pennsylvania and a senior fellow at the Leonard Davis Institute of Health Economics. This is the first in a series of essays, reprinted from the Leonard Davis Institute of Health Economics’ eMagazine, in which scholars who attended the recent AcademyHealth National Health Policy Conference reflect on the experience.


Like Goldilocks wandering through the house of the Three Bears, policy-makers in search of a health care payment model have found it difficult to settle on an option that is "just right."

Fee-for-service—paying doctors separately for each service they provide—leads to too much unnecessary and duplicative care (too hot!). Capitation—paying doctors a fixed fee for caring for patients—leads doctors to skimp on care and avoid costly populations (too cold!). A "just right" payment model should give providers incentives to provide all the clinically necessary care to patients while keeping costs low.

Shared savings models—allowing providers to keep a portion of the money they save caring for patients—have been touted as one method for aligning the incentives of providers and payers. Most prominently, shared savings is a central element of the Affordable Care Act's Accountable Care Organizations (ACOs).

An ACO is a network of providers that have agreed to accept a bundled payment for treating patient populations, and in return stand to gain incentive payments for meeting performance targets (or to lose money for missing targets). In the "happily ever after" version of ACOs, groups of providers will finally have a business case for coordinating patient medical records, reducing costly visits to the emergency room, and improving patient compliance with chronic disease therapies without leading to excessive procedures or gaps in care. Healthy patients, healthy profits.

But will it work?

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