HMO Vs ACO Model

Health Maintenance Organizations (HMO) experienced rapid growth in the 1980s and 1990s as an effort to curtail the rapid growth in healthcare spending. The strategy was that patients would be assigned a primary care physician to act as a gatekeeper, and coordinate all of their healthcare needs. And as a result of this approach, less expensive services would be utilized, and less duplication would occur. This is the primary difference between the HMO and ACO model, as the new ACO models don’t assign a single primary care physician, but rather a network of physicians that participate in the ACO. HMO enrollment peaked in the late 1990s and has been declining ever since. Today, many of those who were enrolled in an HMO have moved into …show more content…
However, physicians who have heard these promises before are wondering if ACOs are just the new version of HMOs, and perhaps consider them as the same lofty concept dressed up in a new way (Freeman, 2013). Many say this is simply just a new version of the HMOs, and the new trend will encounter the same challenges as the previous HMOs faced. Those challenges were created because the primary focus of HMOs were(are??) to decrease costs by the use of a gatekeeper, and in comparison, the focus of the ACOs are to also control the escalating costs of the healthcare sector.????? Physicians were incentivized then (enticed, persuaded??) to control costs through the limiting utilization under the HMOs, and would make a profit if they were able to keep those costs low. The ACO model also incentivizes(is this a word??) physicians and healthcare systems to keep costs at minimum, but also adds an incentive for quality …show more content…
Perhaps many procedures that were actually needed were avoided in order to make a profit. The patient still required the procedure, but it was performed on a later date. As a result, the patient’s condition worsened, and the cost to the healthcare system was much higher overall. The author conducted an interview with Dr. Mubashir Qazi, Cardiologist, on September 15, 2016. Dr. Qazi was practicing during the growth of the HMOs, and witnessed the decline in referrals to specialty physicians. He indicated that many patients needed a cardiology specialist, but were not given access due to being pressured on keeping cost to a minimum. As a result, by the time he was engaged in their treatment, the patients were much sicker, and the overall cost ended up being much higher due to the effort in delaying the appropriate cardiac care (M. Qazi, personal communication, September 15, 2016). Therefore, when one looks at the rise and fall of HMO enrollment, the hindrance of the consumer’s lack of choice and the push to limit physician’s ability to practice as they deem necessary were the reasons HMOs weren’t successful during that