By NextBestFitPhase 3: Waves 2 & 3: working-age adults · Step 3.6
Create integrated care organizations (ICOs)
Years 2–4 · UHADiscuss this step
Pros & cons of this step
Pros
- +Keeps the best-performing integrated systems' model.
- +Gives patients a meaningful choice of care model.
Cons
- −Risk-adjusted capitation invites upcoding (the MA problem).
- −Restricted provider choice for ICO enrollees.
- Choice and integration vs. reintroducing some managed-care gaming.
Trade-off behind each cost item
- New jobs for some displaced workers, but in different roles and places.
Trade-off behind each system change
- Medicare ACOs & CMS Innovation Center modelsKeeps experimentation; ends shared-savings arrangements tied to MA and commercial contracts.
- PACE (Programs of All-Inclusive Care for the Elderly)Preserves a successful integrated model; small programs bear more administrative work to meet ICO rules.
- ACA and Medicare Advantage risk adjustmentRemoves most of the upcoding industry; risk-adjustment gaming can still occur for ICOs.