Special Journal Issue Looks at the Future of Health Care Delivery Reforms

Release Date: 
Monday, June 29, 2015

For immediate release
June 29, 2015
Media Contact:
Julie Jung, 773-702-1168

A major delivery model reform encouraged under the Affordable Care Act has spread quickly across the US and now numbers over 700 throughout the country.

Affordable care organizations (ACOs) are networks of hospitals, physicians, and other health care provides that are encouraged to cooperate by sharing financial and medical responsibility for coordinating care of their enrolled patients.

A special issue titled “Assessing Accountable Care Organizations: Cost, Quality, and Market Power,” in the Journal of Health Politics, Policy and Law, edited by Professor Colleen Grogan at the University of Chicago School of Social Service Administration, analyzes the promise of Accountable Care Organizations from a national and state perspective and assesses whether AOCs will lower costs, increase the quality of health care, and improve population health. 

Grogan writes in an introduction to the issue, “The development of accountable care organizations (ACOs) under the Affordable Care Act (ACA) is the latest in a long line of antitrust concerns about whether the benefits of cooperative delivery model reforms outweigh the costs (due to higher prices) of reduced competition.

“Those who see great hope in cooperation among providers to improve (1) continuity of care and (2) integration across traditionally separate lines of service provision, tend to view competition’s ability to bring about improved quality with skepticism.”

She also pointed out that people who view the evidence for competition as convincing are more skeptical of integrated delivery model reforms, especially if a reduction in competitive behavior results.

“The issue considers the larger amalgamation of tensions—public versus private, competition versus cooperation—that exist within the US health care system,” she continued. “Yet, while there are important voices on both sides of this tension, those grappling with how best to work within a mixed system (perhaps accepting the inevitability of a completely merged public-private US health care system) are represented in this special issue.”

Harold Pollack, the Helen Ross Professor at SSA, a health care policy expert, also contributed an article in the Point/Counter Point section of the journal wherein he challenged the prospect of a single payer health care system and suggested improvements for the Affordable Care Act, upheld last week by the US Supreme Court.

Pollack suggestions for ACA improvements are included as part of a counter-point to an essay promoting a single payer system, sometimes called Medicare for All. He countered a position in favor of the system by contending that political compromises brought on by accommodations to interest groups would create an unworkable system. He also pointed out that the nation is not ready for such a change.

“For the foreseeable future, the main health policy challenge is to make the ACA work,” Pollack wrote in “Medicare for All—If It Were Politically Possible—Would Necessarily Replicate the Defects of Our Current System.”

“Consumers need more automated decision supports to help them navigate the different-tiered plans and to match available offerings to their individual circumstances,” he writes. “We need to pursue comparative effectiveness research and explore new delivery models required to improve care under any broad financing system.”

He also said that new revenue sources may be required in the event that health expenditures rise quickly. “We should also explore ways of making health coverage less burdensome and costly to employers,” he wrote.

Read the Duke University Press announcement.

Faculty Association: 
Colleen GroganHarold Pollack