Health Reform Acronyms

PAPA (Patient Affordability and Protection Act), ACA (Affordability Care Act), ACO (Accountable Care Organization), VACO (Virtual Accountable Care Organization), and OWA (Other Weird Arrangements)

With Obamacare, we are suddenly awash in acronyms. Acronyms are a sneaky way to avoid using the term “Obamacare,” which some people consider to be a virtual pejorative, a virtual attack and slur on the President’s health plan.

Speaking of “virtual,” the Internet now allows us to arrange, rearrange, or simulate virtually anything – to achieve virtual reality, to examine virtually any patient from a distance, to conduct virtual office visits without actually being there, to perform virtual colonoscopies or virtual bronchoscopies, to arrange for the care of virtual chronic diseases by virtually any organization or any combination of entities.

In a September 26 edition of The Health Care blog, futurist Joe Flower tells us how the future of virtual health care will actually work. He says the work to contain costs and lift quality will be done by virtually integrated organizations like Kaiser, Mayo, Boeing, Cigna, Geisinger, CIGNA, and BCBS of Rhode Island, all of which have proven programs that have lowered costs for chronic disease by 14% to 27%.

They do this, he says, through VACOs (Virtual Accountable Care Organizations), in which the relationships between entities and individuals is remote, i.e. virtual, but contractual, changeable, and subject to rebuilding.

Flower predicts,

“VACOs will likely be built into the health plan exchanges as they are deployed in 2014 and after, soon becoming a standard option in all health plans and a major way of competing among health plans. As VACOs show good results in the private market, health plans will find ways of offering them under Medicare. The success and cost differences eventually will be so large that employers will stop offering other alternatives, and Medicare will offer sharp incentives for participating in a VACO; using every resource at our command to help people be healthy will have become the standard model of health coverage.”

The three main ingredients of VACOs, says Flowers, are

1) An entity (like the employer) whose bottom line depends on lowering medical expenses for some class of people.

2) Some "skin in the game" for the individuals covered—which can be turned into incentives for them to participate in improving their health.

3) An entity (for instance, a health plan) with a lot of expertise in managing population health, a real incentive to drive down medical costs, and the willingness to "put a crew on it" to find what works and what doesn't.

I am not sure I understand what VACOs entail. But I do understand there is a lot of talk about ACOs – bundled bills between hospitals and medical staffs, mutual savings by hospitals and doctors, physician hospital organizations, IPAs, integrated hospital systems, engaged employees – and all manner of OWAs (Other Weird Arrangements) based on VMUWEB (Virtual Mutual Understandings Where Everyone Benefits).

In olden pre-acronym days, we called this collaboration and cooperation.

There's virtually no limit to the number of health reform acronyms. The only acronym we're missing is IAAB (Independent Acronym Advisory Board). I'd be glad to serve as a member of the board.