Among practitioners and proponents, the accountable care organization (ACO) model is usually characterized as a disruptive innovation in US health care that reflects over two decades of calls for quality-based payments within Medicare. Some academic analyses are more circumspect (Burns and Pauly 2012) and question whether they differ substantially enough to overcome some of the issues observed when other policy innovations were introduced. In this special issue, Robert Berenson (2015), Roger Feldman (2015), Eric Kessell et al. (2015), and Lawrence P. Casalino et al. (2015), respectively, highlight pricing, cost bases, quality, and population health components of this new model. Their articles point to ACOs as conforming to long-standing patterns in US health policy: overconfidence in the level of policy disruption occurring and, relatedly, underestimation of the potential for strategic adaptation by providers. Those adaptations potentially undermine the changes that are introduced,...
Commentary — payment Policy Disruption and Policy Drift
Miriam J. Laugesen is a political scientist and assistant professor in the Department of Health Policy and Management at Columbia University. Much of her past and ongoing research is focused on the politics of physician payment policy, particularly on the Resource-Based Relative Value Scale (RBRVS), which is used for pricing medical services across all sectors of the US health care system. She received a Robert Wood Johnson Foundation Investigator Award in Health Policy Research to research the RBRVS, and her recent publications explore specialty and primary care fee differentials in the United States and five other countries, the rule-making process used to update the RBRVS, patient-centered medical homes, integrated delivery systems, and the Affordable Care Act. She is coauthor, with Robin Gauld, of Democratic Governance and Health (2012).
Miriam J. Laugesen; Commentary — payment Policy Disruption and Policy Drift. J Health Polit Policy Law 1 August 2015; 40 (4): 839–846. doi: https://doi.org/10.1215/03616878-3150088
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