The Accountable Care Organization: Think opportunity, not threat

Accountable care is here – both as a way of doing business and an approach to providing high quality health care.  With accountable care, the potential for reducing overall health care costs, realigning incentives and focusing clinical resources on prevention and disease management is now a real opportunity. Physicians who aren’t ready to transition their practices to operate in a manner required under accountable care models will increasingly find themselves in an uncompetitive position. They will find their patients gravitating toward physicians that are taking a more coordinated approach to health care due to benefit design changes in private health plans, governmental programs, and hospital-physician clinical integration activities.

Some physicians perceive accountable care organizations (ACOs) as a threat – as a way to take their money out of the system and put more control, somebody else’s control, into the system. But effective ACO models embrace physician and patient decision-making and use physician expertise to design a more patient-oriented care delivery model. This new model can then be achieved with technology, business model process redesigns, and aligned incentives so that care is done in the most effective and efficient manner. Done right, this approach will deliver greater value for everyone involved, including the physician.

If you are a physician, there is no shortage of talk about ACOs. But where do you start? It all starts with a clear understanding of the end-state vision: How will I get paid in the future? How should the care delivery model align with the payment models? What changes must my staff embrace for the new model to work? Do I have the right people? What’s the patient experience? What must we do to get there?

There are plenty of resources available to physicians interested in moving toward accountable care. Moving to a new model while you still have a practice to run will not be easy.  Nevertheless, doing so presents so many possibilities and opportunities.

One such opportunity is the chance to come together with like-minded professionals and create a care system that reflects your values, capitalizes on your skills and works for the benefit of your patients. Not everyone is equally committed to making the changes in business processes, technology and staffing to truly manage patients effectively across the care continuum. So it’s important to choose your partners wisely.

The second opportunity in redesigning your model for accountable care is the chance to capitalize on new technology – beyond a traditional electronic medical record (EMR). You need technology that provides much greater access to patient information, clinical guidance, and business intelligence to track and manage patient care outcomes. Traditional EMRs, even when linked to Health Information Exchanges, are a poor foundation for accountable care.  Having a clear understanding of how technology can make your ACO successful is critical to success in the post reform health care industry.

The third opportunity in accountable care is to be paid for delivering better and more efficient patient care. The federal government, private payers, and many state governments have recognized that opportunities to improve efficiency of care delivery offers the best opportunity to maintain the richness of health plan benefit designs while blunting never-ending cost increases. Programs such as the Pioneer Program, the Medicare Shared Savings Program, and various bundled payment designs are being introduced by private and governmental payers to reward high quality, efficient care.

The compensation models actually give physicians more control over the care model they want to create – spending more time than they currently spend addressing patients’ health care needs before they become ill. The emphasis on preventive care and patient outreach should lead to more satisfied patients over time, while at the same time providing greater financial gains to those physicians whose care models result in better overall patient care.

The opportunities exist now.  Patient-centered, accountable care is the right thing to do — for physicians, for patients and for our nation.

Charles Kennedy is an internal medicine physician, and CEO, Aetna Accountable Care Solutions

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