The joke around healthcare conferences these days is that accountable care organizations are like unicorns everyone has heard of them, but nobody has seen one. Almost every week we hear of a new ACO being formed, as physicians and hospitals team up to prepare for this new reimbursement model, scheduled to debut in 2012. The goal of ACOs is to better coordinate care for an assigned group of patients, and reward hospitals and physicians for doing so. It sounds sort of like HMOs, except that insurers aren't necessarily in the mix, and at least initially, ACOs aren't taking on full risk. ACOs must include at least one hospital, 50 physicians and 5,000 Medicare fee-for-service beneficiaries, but beyond that, the concept gets fairly fuzzy.

The Centers for Medicare & Medicaid Services is scheduled to issue ACO rules any day now, which presumably will give the organizations clear guidelines on structure and operations. But in the meantime, look no further than several integrated healthcare systems to see what the federal government has in mind: Geisinger Health System, the Mayo Clinic, the Cleveland Clinic, Kaiser Permanente and Scott & White Healthcare. These are provider-owned systems touted for coordinating care across specialties and running more efficient operations than other hospitals. They employ their own physicians, have electronic medical records, and are already deeply involved in comparative effectiveness research and quality initiatives. In the case of Geisinger, Kaiser and Scott & White, they also own their own health plans. These are the players that will have the advantage when ACOs get underway although judging from the number of ACO wannabees, they will have lots of competition.

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