How organizations will work

Under an accountable care organization, insurers will track how patients fare, and compare the outcome to how they would have been expected to fare under the traditional system. If the new organization saves money, it will get a share. Wellmark leaders say it plans to give up to 75 percent of savings to health care providers, who also will be measured on patient satisfaction scores gleaned from surveys. At first, hospitals and doctors wont face much financial risk for participating. But over time, they could have fewer patients filling hospital beds and undergoing expensive procedures. Eventually, insurers are expected to pay a set amount for a large group of patients, then let the accountable care organization figure out how to provide effective care for that money. The patients would be free to go elsewhere for care, which the accountable care organization would have to finance. Supporters of the idea say that would give the organizations a huge incentive to make sure their patients are pleased.

WHAT THEY ARE: A new way of paying hospitals, doctors and other health care providers based in part on how their patients fare. WHAT THEY MEAN FOR PATIENTS: You wont necessarily be notified that your care is being provided by an accountable care organization. Youll remain free to switch doctors or go directly to specialists. Patients with chronic conditions will most likely be affected first. THE GOAL: Reward hospitals and doctors for improving patients health, which would translate into fewer hospitalizations and lower costs. CRITICISMS: The new organizations will accelerate consolidation of independent doctors practices into large medical systems, which would reduce competition and patient choice.

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New health care payment system links costs, patients' outcomes