Attached is a link to the news release regarding Horizon’s announcement for ACOs and PCMHs.  One of the most important parts of the article is the quote from Linda J. Schwimmer where she stated, “(This will only work) if the providers actually do manage patients well and have all the things that drive down cost.”  She also stated, “There are specific things the doctors are going to need to do to drive down costs and hit the quality metrics.”

In joining either of these delivery systems, providers must be careful to review the rates they will be paid, the calculation of the quality metrics, what they will be paid if they meet the quality metrics, and their ability or the ability of the delivery system to compel the beneficiary/patients to conform to the required medical regimen so that the metrics can be met.

Currently, the noncompliance by patients with the medical regime prescribed by the physician or other providers, is on the third party payors.  This clearly is an attempt by Horizon to shift that risk and the expenses incurred, as a result of the patient’s noncompliance, to the provider.