One of the next steps in the evolution of the health care system is the addition of ACO-backed care to private health insurance exchanges.

Private exchanges, which already are attracting some attention from employers, may be a good avenue for hospitals and health systems that are seeking to provide the value-linked care of an ACO in a local or regional market.

Companies like Bloom Health and Aetna are active in this arena and I'm sure there are others at least looking at how they might include an ACO on a private exchange.

Officials for Bloom say that private-exchange ACOs have worked well in Minnesota, the only market where the exchange-platform company has offered them so far.

Interest has grown enough that Bloom offers four ACOs, and currently has almost 7,000 employees in private exchange ACOs, says Simeon Schindelman, chairman and CEO of Bloom.

Importantly, among those employers offering them, close to 50 percent of employees who are eligible for an ACO in the network choose one, a big difference from the typical 5 to 10 percent levels of participation garnered by a narrow network health insurance benefit option, Schindelman says.

Patients like the ACO option because of the health and wellness features offered as part of its value-oriented approach and because it costs less than a broad network plan, he says.

Schindelman argues that the addition of the ACO could be important for hospitals and health systems. "It gives them a chance to market themselves, promote themselves, productize what they do and earn the loyalty of consumers who sign up to work with that system."

The potential for health systems to benefit from private exchange ACOs also has caught the attention of the large health insurer Aetna. On a conference call last month, Aetna's chairman, president and CEO, Mark Bertolini, outlined how private exchange ACOs are one of the new areas the insurer is exploring, and the company views them as a means for smaller providers to compete nationally.

"The other models that we’re experimenting with and are launching here very soon are private exchanges bolted onto the front of our ACO models where those provider systems in those communities can be able to sign up individual and small group [plans] and participate in what we’ll create as a national ACO chain," Bertolini said on the call.  

Aetna noted in a separate statement that "ACOs can bring very attractive value propositions (cost and quality) in their market where the ACO provider partner has strong local market recognition. … Access to ACOs will be a critical differentiator in the market for our exchanges, as will the consumer experience offered on the exchanges, and the impact that the exchange offerings have on cost trends."

ACOs have been criticized frequently as being flawed vehicles of care. That may be true; nobody can know for sure. But when a deep-thinking but tough CEO like Bertolini gets behind the model, one has to think their chances of gaining use in some form have to be pretty good.

It feels odd to be writing something positive about ACOs. Maybe you can tell me why. Feel free to do so in the comment section or via email, Twitter and Google+.

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