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ACO, Antitrust, Shared Savings Program, Patient Protection and Affordable Care Act, health care, competiion, accountable care organization


When pressed for evidence that the proposed health reform legislation will control costs, proponents invariably cite the numerous pilot programs and other innovations in Medicare payment policy contained in the bill. At first blush, the ACO model seems well designed to foster competition among providers. Not unlike health maintenance organizations and other integrated delivery forms, ACOs assume responsibility for coordinating care and thus have strong incentives to provide cost effective care and to do so in a manner that is transparent and hospitable to comparative shoppers. But at the same time, the path of ACO development could prove profoundly anti-competitive. The concern lies with the possible exacerbation of already-weak competitive conditions prevailing in provider markets. This essay, written at as the Patient Protection and Affordable Care Act was enacted, discusses competition policy issues associated with the Shared Savings Program.