Leavitt Patners has produced a map showing ACO development intensity in various regions of the United States. You may see it here: http://medcitynews.com/2013/08/acos-by-the-numbers-where-are-we-now/
The map tells us a few things that make sense: as Medicare ACOs increase in numbers, ACOs participating in the MSSP or Pioneer ACO program have come to dominate the ACO landscape, ACO growth lags in rural areas, there is a multiplictiy of ACO models at play: smaller physician group initiated, large hospital centered, and multiple provider entity models.
Of course, with the exception of the small physician group centered model, these entities all have the advantage of size — both as to larger number of covered lives and number of providers. This may not be a bad thing, though increased provider concentration has been anything but a nostrum for health care inflation cost control to date, but they surely highlight the challenges of establishing a rural or semi-rural ACO.
Last week at SEALS, in a roundtable on ACOs, Professor Jessica Mantel (Univ. of Houston Law Center) mentioned the rural ACO gap. I have been thinking ever since about the realities of expecting rural would-be patients to travel some distance for health care. Would they travel or self-ration? Health care antitrust analysis teaches us that most patients — when considered from the perspective of acceptable travel times — are reluctant to travel far for health care, both for the time and expense involved as well as the not inconsiderable fear of being hospitalized far from loved ones. Would reasonable travel times for primary care have to be different from those for specialty care? All specialty care? In-patient care?
In a world where health care consumers are increasingly urged not to approach hospitalization alone, will travel for in-patient care promised as higher quality and lower cost appeal or not?