Accountable Care Organizations: Regulation and Organization

Sponsor

California Attorney General

Principle Investigator

Richard Scheffler, PhD

Dates

September 1, 2013 – August 31, 2015

About

Project Overview

In 2013, Dr. Richard Scheffler and the Petris Center on Health Care Markets and Consumer Welfare were awarded support from the Attorney General Kamala Harris’ office to examine regulatory approaches for and market impacts of Accountable Care Organizations (ACOs). The two year project included:

  • Two ACO workshops hosted at the University of California, Berkeley;
  • A special issue of the Journal of Health Policy, Politics, and Law; and
  • A report on the regulation of commercial ACOs, to be co-published with the Milbank Memorial Foundation.

Project Summary: Year One

In the first year of the project, the Petris Center convened the Spring 2014 Accountable Care Organization Workshop at the University of California, Berkeley and published a special issue of the Journal of Health Policy, Politics and Law on Accountable Care Organizations.

Project Summary: Year Two

In the second year of the project, the Petris Center convened the Spring 2015 Accountable Care Organization Workshop at the University of California, Berkeley and completed a comprehensive policy report on the regulation of ACOs, which will be co-published with the Milbank Memorial Foundation in the Fall of 2015.

The Petris Center report, State Actions to Promote and Restrain Commercial ACOs, presents and discusses regulations and actions states can take to either promote the development or restrain the actions of ACOs in the commercial sector. Part 1 of this report draws on evidence from the literature and four case studies to outline tools that state governments can use to promote the potential benefits of ACOs while mitigating their potential risks. In Part 2, we apply these lessons to a large state with a rapidly growing ACO market: California. This part outlines policy guidelines for regulators and antitrust enforcement agencies in the state seeking to promote or restrain ACOs.

Advisory Committee

Deborah Feinstein – Director, FTC Bureau of Competition

Kathleen Foote – Senior Assistant Attorney General and Antitrust Chief in the California Attorney General’s Office

H.E. (Ted) Frech III – Professor of Economics at the University of California Santa Barbara

Martin Gaynor – Director, FTC Bureau of Economics

Deborah Haas-Wilson – Marilyn Carlson Nelson Professor of Economics at Smith College

Ben Handel – Assistant Professor of Economics at University of California, Berkeley

Patrick Kuhlmann – Antitrust Division, U.S. Department of Justice

Peter Mucchetti  – Chief, Litigation I Section, Antitrust Division, U.S. Department of Justice

Richard Scheffler – Distinguished Professor, Health Economics and Public Policy, University of California, Berkeley

Stephen Shortell – Blue Cross of California Distinguished Professor of Health Policy & Management, Professor of Organization Behavior

Emilio Varanini – Deputy Attorney General in the Antitrust Section of the California Attorney General’s Office

Staff

Brent Fulton, PhD – Assistant Adjunct Professor of Health Economics and Public Policy, University of California Berkeley

Ann Hollingshead – Graduate Student, Masters of Public Policy, University of California Berkeley

Beth Keolanui – Graduate Student, Masters of Public Health, University of California, Berkeley

Eric Kessell, PhD – Policy Analyst, Berkeley Forum, University of California Berkeley

Vishaal Pegany  – Graduate Student, Masters of Public Health and Public Policy, University of California Berkeley

Kati Phillips – Program Manager, Nicholas C. Petris Center, University of California, Berkeley

Joshua Rushakoff – Medical Student, UCSF

Christopher Whaley – PhD Candidate, Health Services and Policy Analysis, University of California Berkeley

 

Workshop 1: April 24 and 25, 2014

A special issue of the Journal of Health Politics, Policy and Law was commissioned from papers created for the 2014 ACO workshop. The “Assessing Accountable Care Organizations: Cost, Quality, and Market Power” a special issue (volume 40, issue 4), is an in-depth look at accountable care organizations (ACOs): networks of hospitals, physicians, or other health care providers that share financial and medical responsibility for the coordinated care of a patient. The articles below are works supported by the Petris Center.

The press release announcing the journal’s publishing can be found here, and the full journal can be accessed here.

Introduction

Part I: The Current Landscape

Part II: What Do We Wants ACOs to Achieve and Can They Do It?

Part III: ACO Accountability and Enforcement: An Overview and Perspective Essays

 

Workshop 2: May 8, 2015

Panel 1: State Experiences and Existing Approaches for Regulating ACOs

In this panel, speakers and commentators summarized existing approaches for regulating ACOs among those states that have the most experience and innovation in this area. These regulations might address anti-competitive behavior, quality of care, network adequacy, and reporting requirements. We also asked speakers to consider the various successes and failures of alternative regulatory approaches.

Chair

  • Kathleen Foote, JD; Senior Assistant Attorney General and Antitrust Chief, Attorney General’s Office, State of California

Participants

  • Kim Van Winkle, JD, MPA; Antitrust Section Chief, Texas Attorney General’s Office
  • Katherine Mills, JD, MPH; Acting Policy Director for Market Performance Massachusetts Health Policy Commission
  • Herb Olson, JD; Legal Counsel, Rhode Island Office of the Health Insurance Commissioner
  • James R. Knickman, PhD; President and Chief Executive Officer of the New York State Health Foundation
  • Ann Hollingshead, MPP (Candidate); Research Associate, Nicholas C. Petris Center, School of Public Health, University of California, Berkeley

Commentator

  • Greg Burke, MPA; Director of Innovation Strategies; United Hospital Fund of New York City (UHF)

 

Panel 2: Exploring Regulatory Options to Ensure a Competitive Market

In this panel, speakers and commentators explored potential and future approaches for regulating anti-competitive practices, including mergers and exclusivity contracts, and alternatives for regulators to reduce the potential for anti-competitive behavior.

Moderator

  • Emilio Varanini, JD; Deputy Attorney General in the Antitrust Section, State of California

Participants

  • Thomas N. Dahdouh, JD; Regional Director of the Federal Trade Commission’s Western Region offices in San Francisco and Los Angeles, Federal Trade Commission
  • Joshua Soven, JD; Partner, Gibson, Dunn & Crutcher LLP, Washington, D.C. Office
  • Ann M. Marciarille, PhD; Associate Professor School of Law, University of Missouri
  • Jaime S. King JD, PhD; Professor of Law, University of California, Hastings College of Law; Associate Director of the University of California, San Francisco/University of California, Hastings Consortium on Law, Science and Health Policy; Executive Editor of The Source on Healthcare Price and Competition

Commentators

  • Maribeth Shannon, MSHA; Director, Market and Policy Monitor Program, California Healthcare Foundation
  • Emilio Varanini, JD; Deputy Attorney General in the Antitrust Section, State of California

 

Panel 3: Financial and Clinical Integration of ACOs

In this panel, speakers and commentators will explore different types of integration and consider their implications for patient quality, costs, and regulations. Some potential topics include: (1) a taxonomy of ACOs that describes the existing array of integrated structures; (2) payer-provider and provider-provider legal relationships that achieve optimize quality improvements without corresponding increases in costs; and (3) a discussion of the tradeoffs and benefits of financial integration over clinical integration.

Moderator

  • Stephen Shortell, PhD, MBA, MPH; Blue Cross of California Distinguished Professor of Health Policy and Management; Director, Center for Healthcare Organizational and Innovation Research (CHOIR); Dean Emeritus, School of Public Health; Professor of Organization Behavior, Haas School of Business, University of California, Berkeley

Participants

  • Gerald F Kominski, PhD; Professor, Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles; Director, University of California, Los Angeles Center for Health Policy Research
  • Jill Yegian, PhD; Interim-Chief Executive Officer and Senior Vice President for Programs, Integrated Healthcare Association
  • Bruce Bodaken, MS; Visiting Scholar; Brookings Lecturer, School of Public Health, UC Berkeley; Former Chairman, President and CEO, Blue Shield of California
  • John Wiegand, JD; Attorney, Federal Trade Commission – San Francisco Office
  • Kenneth W. Kizer, MD, MPH, Distinguished Professor and Director, Institute for Population Health Improvement, University of California Davis

Commentators

  • Stephen Shortell, PhD, MBA, MPH; Blue Cross of California Distinguished Professor of Health Policy and Management; Director, Center for Healthcare Organizational and Innovation Research (CHOIR); Dean Emeritus, School of Public Health; Professor of Organization Behavior, Haas School of Business, University of California, Berkeley
  • Laurence Baker, PhD; Health Economist and Professor of Health Research and Policy at Stanford University