Wonkblog:

The health care law’s Accountable Care Organizations often get compared to unicorns: We know what they are supposed to look like, but have never actually seen one.

ACOs are meant to move us away from an expensive, broken health care system that rewards doctors for providing a high volume of care and move us towards one that rewards higher quality. They involve groups of doctors accepting flat fees to manage the care of a given set of Medicare patients. If the doctors deliver high-quality care in a cost-effective way, they net any savings left over.

It all sounds great in concept. In practice though, ACOs have proved just as elusive as mythical beasts. That’s what makes a new Health Affairs paper exciting. Harvard researchers have found something that looks a whole lot like their unicorn: An ACO that is up, running and looks to be delivering the exact results everyone has hoped for.

Blue Cross Blue Shield of Massachusetts spent years paying health care providers for each service they provided, just like the rest of the health care system. Three years ago, they offered doctors a payment model that looked a whole lot like an ACO.

Physicians and hospitals could accept a lump sum for all care delivered to a group of patients. If they could deliver medical care for less than that amount – while hitting certain quality metrics – the providers would net a profit. There’s was also a risk: Providers who spent too much would eat the difference.

This project is called the Alternative Quality Contract. In yesterday’s Health Affairs, a team of Harvard researchers published a long look at how its been doing – and it looks to do be doing pretty well.