ACO debate is alive and well

As a health care wonk, it warms my heart to see six strong letters on Accountable Care Organizations in today's Wall Street Journal, each with a different perspective. The letters are substantive and bereft of ad hominen attacks --which is a definite step up from other top topics of our day. To quickly summarize:

• The CEO of the Physicians Foundation says ACOs have already failed, because consolidation of provider systems leads to higher prices than with independent physician practices
• An MD/PhD asserts that in seeking low cost, access and quality only 2 out of 3 can be achieved
• The Chief Medical Officer of Cigna reports good initial results from experience with 50 ACOs
• A surgeon is concerned that ACOs will keep too many patients in primary care and away from specialists
• A physician complains that patients still have no skin in the game and that the liability system needs to change
• The CEO of a Medicare Advantage insurance company touts the quality and cost benefits of ACOs

So there you have it. I see merits and flaws in all these arguments. There will be plenty more to discuss as the ACO experiment proceeds.