, Volume 27, Issue 5, pp 487-489
Date: 29 Feb 2012

The Un-managed System of Medicare Referrals

This is an excerpt from the content

Since the passage of the Affordable Care Act two years ago, patient centered medical homes (PCMH) and accountable care organizations (ACO) have emerged as leading models to address our fragmented, high cost health care system.1 The Center for Medicare and Medicaid Innovation (CMMI) has been allocated $10 billion over a decade to test and spread these and other new models of care and payment, with the aim of providing better health for individuals and populations at lower cost.

Last December, CMMI chose 32 organizations across the country to participate in its “Pioneer ACO” program. These ACOs are defined as “groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve.”2 If the ACOs provide care for their patients at a lower cost than would otherwise be predicted, they share in the cost savings; if their costs are higher than predicted, they share the losses.

Notable elements of the ...