Do ACOs Raise Anti-Trust Concerns?

Encouraging physicians and hospitals to come together to form Accountable Care Organizations (ACOs) to serve fee-for-service Medicare patients is a key cost control and quality improvement feature of the Affordable Care Act (ACA).

In an ACO, independent providers form integrated delivery systems to offer more efficient care for a defined population of patients.  Many policy-makers hope Medicare ACOs will increase care coordination and spur the expansion of these collaborations in the private market.

ACOs are promising vehicles for delivering health care more efficiently, but some insurers and regulators worry they could reduce competition and drive up prices.

Regulators have outlined final criteria for judging whether a Medicare-qualified ACO is anti-competitive in the private market. They also cautioned ACOs against certain practices that could be anti-competitive.

This Health Policy Snapshot, published online in October 2012, examines anti-trust concerns over ACOs and how regulators are handling the issue.

Read more from RWJF's Health Policy Snapshot series.

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