The Case for Enrolling High-Cost Patients in an ACO

Abstract

Though accountable care organizations (ACOs) are increasingly important to American healthcare, ethical inquiry into ACOs remains in its nascent stages. Several articles have raised the concern that ACOs have an incentive to avoid enrolling high-cost patients and, thereby, have an incentive to deny care to those who need it the most. This concern is borne out by the reports of consultants working with newly formed ACOs. This paper argues that, contra initial appearances, there is no financial incentive for ACOs to avoid enrolling high-cost patients.

Keywords: Accountable care organizations; Bioethics; Healthcare expenditures; High-cost patients; Medical ethics; Patient Protection and Affordable Care Act.