ACO- Accountable Care Organization- Nothing New… It’s A Senior Capitated PHO/IPA Rebranded

Many details of healthcare reform are still unknown; as Ms. Pelosi, our former Speaker of The House, was quoted when pushing healthcare reform through that “we have to pass the [health care reform] bill so you can find what’s in it. Obviously, this is backwards logic, as are much of political decisions.”

There are however a few good ideas in the healthcare reform, and one of them are ACO’s. ACO’s are (as proposed) integrated systems where providers and facilities work in tandem to minimize cost of healthcare for seniors while maintaining quality care. To accomplish this, the ACO will be given a defined budget, and will reap rewards if they spend less (ration healthcare) than the budget, or be punished (i.e. pay for it) if they exceed the budget.

This is not new, this is capitation and manages care, and the ACO is just a new name for a PHO or IPA. This idea has been around since the late 1980’s. It is prevalent throughout California. It is a concept that works at controlling costs. If most Americans were on capitated health plans, we would not need healthcare reform.

There will be backlash to ACO’s, this new/old concept, as seniors learn the details from slick PR Firms, whose employers want more and more of our GNP going down the drain in fee for service models. Capitation (defined budget healthcare) works and it caps spending. It eliminates fraud and creates an environment where healthcare can be rationed with sanity, versus money being sent through a fire hose (at max PSI) at a senior as they lay dying in the ICU.

In response to this we have a new stop loss product; ACO Stop Loss Reinsurance. Which will provide an outlier of reimbursement for the unpredictable shock loss claim, either stop loss reinsurance based on a per member basis, or on an aggregate budget basis.

HCP National is a Managed Care Stop Loss and Managed Care Reinsurance Broker and Reinsurance Intermediary. We do HMO Reinsurance and Provider Stop Loss and Employer Stop Loss and soon to be ACO Reinsurance and ACO Stop Loss

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