How the ACO model can be successful

by Justin Chang, MD

I think we can all agree — physician, payer, provider, patient, etc. — that the ultimate goal of regulations and reform should be to improve the delivery of healthcare, lowering costs and ultimately, making patients healthier and more satisfied.

Coupled with driving toward the results defined by CMS, this requires some fairly significant changes in how healthcare providers operate — changes which may rightfully make some providers uneasy.

But what many of us may not realize is that hospitals, physicians and payers across the country are already becoming advocates for the types of changes ACOs will require, supporting a shift away from the fee-for-service and silo-type models, even before the regulations go into effect.

At Kaiser Permanente, we’ve been operating under an integrated healthcare delivery model for quite some time by establishing a large, multi-specialty group that is salaried and aligned around organizational objectives. The physicians in our group utilize the same electronic medical records, standardize ordering around similar, evidence-based protocols, and this helps the network monitor groups for performance.

As a result, we’re one of very few emergency departments in the area with decreasing CAT scan rates, while the national trend rises. In the past 2-3 years, we’ve been working to collect even more data to help show that increased utilization, i.e. CAT scans, does not necessarily improve results, and that achieving a drop in these expensive tests does not result in worse results, increased risks, or missed diagnoses.

In my opinion, the ACO model can be successful if these important pieces come together:

  • Collaboration: A wide variety of care providers need to be willing to work together toward a common goal of better results  for patients if the ACO model is going to work.
  • Network support:  In addition, support for the networks behind all these providers — meaning chronic care coordinators, case management, nursing, even dietary — will be especially important.
  • Patient focus: Systems, policies, procedures and protocols must be patient centric, not physician-, hospital- or insurance-centric. That’s my litmus test.

Strip away its definition and you’ll find that ACO means physicians will take care of patients by providing a spectrum of care at a predefined cost, and that better outcomes, not price, will be the true measure of success. And beyond ACOs and how the money flows, the ultimate victory will be physicians partnering with each other, using technology to collaborate and share information, with support personnel who oversee the patient’s overall health and manage the transitions.

Justin Chang is chief of emergency services, Kaiser Permanente, Colorado, and medical director, Exempla St. Joseph Hospital Emergency Department.

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