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The former have demonstrated savings of 4 percent, while hospital-based ACOs have not realized significant savings.“The benefits of primary care ACOs are real, undercounted and will grow over time,” Mostashari said. He said one impediment to expanding practice-led ACOs is the ongoing specter of small physician practices being purchased by hospitals. This trend of consolidation is also working against attempts to reduce total cost of care. “It’s not good for health care costs,” Mostashari explained. “You don’t have a market if you have a monopoly. We have to do something about consolidation.” ACOs are often discussed as a gateway to risk-sharing payment models, but insurers and physicians are still working out how much risk practices should be accountable for. The panelists agreed that a primary care physician should not be responsible for total cost of care because that is outside any single physician’s control. If insurers committed to investing more of the nation’s health care spending in primary care, the result would likely reduce the total cost of care, panelists said.

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