Bioethics for Breakfast: ACOs: Are They New or Just HMOs in Sheep’s Clothing?

bioethics-for-breakfastJanet Olszewski, MSW, and Ann Mongoven, Ph.D., presented at the Bioethics for Breakfast event on Februray 20, 2014, offering views on the topic, “ACOs: Are They New or Just HMOs in Sheep’s Clothing?”

The Affordable Care Act (“ACA”) and many contemporary health policy analysts promote the development of Accountable Care Organizations (“ACOs”) as a desirable change in the health care delivery system and insurance landscape. They believe ACOs will be able to increase health care value by simultaneously improving quality and lowering costs. Currently, Medicare demonstration projects initiated by the ACA are developing ACOs, while private payers are also experimenting with them, including “the Blues” in Michigan.

Accountable Care Organizations have been introduced as a new attempt to integrate finance and delivery systems, develop global budget targets for regional populations, improve quality and efficiency of care through increased coordination of care and better align financial reward with efficiency and value of care provided. That set of goals is quite similar to those set forth when Health Maintenance Organizations (“HMOs”) were introduced last century. The speakers examined the history and evolution of HMOs, assessed the extent to which ACOs resemble HMO health financing and delivery schemes, and explored ethical tensions embedded in new ACO configurations.

Janet Olszewski, MSW
In her current role as Principal of Health Management Associates, Ms. Olszewski assists institutional clients with strategic planning related to health reform. Formerly, she was the Director of the Michigan Department of Community Health during the Granholm administration (2003-08). While director, she oversaw the development of a new Medicaid managed care program and a patient-centered medical home initiative. Ms. Olszewski spent more than 23 years working for the State of Michigan in various capacities. She is also a former Vice President of M-Care, a health plan owned by the University of Michigan.

Ann Mongoven, Ph.D.
Ann Mongoven is an assistant professor in Michigan State University’s Center for Ethics and Humanities in the Life Sciences and Department of Pediatrics. She is the author of Just Love: Transforming Civic Virtue (Indiana University Press, 2009). Her research interests are in public health ethics. She directs a multi-faculty health policy course for MSU medical students.

About Bioethics for Breakfast:

In 2010, Hall, Render, Killian, Heath & Lyman invited the Center for Ethics to partner on a bioethics seminar series. The Center for Ethics and Hall Render invite guests from the health professions, religious and community organizations, political circles, and the academy to engage in lively discussions of topics spanning the worlds of bioethics, health law, business, and policy. For each event, the Center selects from a wide range of controversial issues and provides two presenters either from our own faculty or invited guests, who offer distinctive, and sometimes clashing, perspectives. Those brief presentations are followed by a moderated open discussion.