ACOs grew out of various pilot projects that seek to tie provider reimbursement to patient outcomes, cost, and patient satisfaction. Although the formal ACO is a Medicare project, payers and providers are rapidly developing ACO-type models for commercially insured beneficiaries. These models range in complexity and risk from a fee-for service model (with shared savings) to a capitation model that leaves physicians with downside financial risk if costs increase or quality worsens. If successful, ACOs will be responsible for millions of patients and will have a powerful impact on prescribing behaviour.
This U.S. Physician and Payer Forum explores how the development and launch of payer-provider contracting arrangements known as ‘Accountable Care Organizations’ are affecting brand prescribing. Analysis is based on a survey of 140 prescribers (primary care physicians and endocrinologists) and 25 pharmacy and medical directors at MCOs that currently contract with an ACO-type structure, or plan to do so within the next 12 months. By understanding how the development of ACOs will impact prescribing behavior, drug developers can begin to identify how to leverage these programs to favor, or at least protect their brands. We focus on cardiovascular and metabolic conditions—the areas that will see the greatest emphasis over the next year.