We have brought you a lot of information on the emergence of Accountable Care Organizations (ACOs) as a new model for healthcare. Many practitioners are starting to see the value of ACOs because Medicare payment models feature the "upside-only" shared savings. This means that Medicare is not penalizing practices if they don’t meet savings targets. This "upside-only" concept allows practices to make investments in permanent infrastructure such as preventive care, chronic disease management, medical homes, technology and provider networks without forcing them to go broke. These practices are now looking to do the same thing with commercial payers but the latter are not willing to do "upside-only" plans with the practices, and many of these commercial payers are still working on "downside" programs that penalize providers for not meeting targets they agree with. This is preventing many practices that have large commercial patient bases from participating in an ACO. Hopefully as more practices get involved in ACOs there will be a greater push to "upside only" shared savings in commercial plans.
I get to spend a good amount of time helping physicians manage insulin therapy and find that often patients feel more comfortable talking to an educator that they do their own prescriber. It could be that they feel we are more likely to listen and help them work through their fears and problems, and now a new study from University of California, San Francisco, Fresno Medical Center, shows that nurse educators can do a great job in managing insulin therapy and improving A1c.
Dave Joffe, Editor-in-chief