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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  • Stacy Bowen

    I wish you could have been at the Michigan Senate insurance committee hearings this summer. Four proposed bills were on the table to make docs LESS accountable. It was ridiculous. The bills have been shelved for now, but Patients Come First!

  • Margalit Gur-Arie

    I don’t know what “Patient-centered, accountable care” really means, but assuming that our way of life is now different than what it was when people lived their entire life within 20 miles of where they were born, and seeing how medical technology is creating multiple venues for obtaining care, some coordination seems necessary and also beneficial to patients. However, does this really require massive restructuring of the current system? If all we are proposing to do is to align financial incentives of the delivery system with proactive coordination of care for patients, why not just pay for such coordination? If fee-for-service supposedly brought us more service, why not try fee-for-coordination?

    I made this suggestion over a year ago, and I am glad to see the new coordination CPTs in the 2013 Medicare PFS, but that’s not nearly enough and it looks a bit indecisive anyway.

    It is also useful to remember that coordination may be an administrative necessity nowadays, but (longitudinal) continuity, to any degree possible, may be even more important to improving outcomes and reducing costs, and none of these new frameworks seem to be too terribly concerned with that aspect of care, and quite the opposite is underway, presumably as an “unintended consequence”?

  • Roberto Galfi

    Roberto Galfi In my point of view this is the future of the total support for Healthcare Markets and main players. The real challenge is how to do it….

  • buzzkillersmith

    They’re not going to work, although they will make some bucks for guys like Chuck. ACOs are based on the idea that hospitals and doctors will work together. But doctors loathe hospital administrators. Has anyone thought of that? And by the way, doctors don’t particularly care for the medical groups that they are not part of. That’s kind of why they’re not in those medical groups.
    It’s easy to see how this will go down. The hucksters will create some buzz, and the downtrodden docs will meekly submit. Maybe some initial foolish enthusiasm, especially if the food is good at the “brain-storming”meetings and free pens and coffee mugs are on offer, but then the huge investments of time and treasure will begin to take hold, even as the every-charming huckster continues to try to rally the troops. In time, well, who could have predicted it?, that extra revenue won’t materialize or won’t cover initial expenses or will be so puny as to not the initial work in the first place. Docs will start to drop out and things will unravel quickly indeed. Another idiotic (but for some, lucrative) medico-business fad on the trash-heap. Oh well, on to the next one.
    ACOs posit a degree of cooperation that is simply impossible without central authority.
    If you want to control docs, you must have the power to hire and fire them. I see nothing like that here. It’s like the PPOs and non-staff-model HMOs. It’s like a coop of headless chickens in white coats running around mindlessly. Not really a threat. More of a ruse, a con, maybe laced with a bit of desperate Hail Mary.

    • Margalit Gur-Arie

      “If you want to control docs, you must have the power to hire and fire them.”

      They know that and if you look around you, this is what is happening more often than not with new docs and also plenty of old docs. Barring some mass epiphany amongst physicians, they day is not very far where medicine will come under corporate control, just like every other profession before it, and with similar results in “quality” of service and reimbursement thereof.

      • Michael Planchart

        I couldn’t affirm whether ACOs will be good or bad. We will not know until we see the results of the pioneers and the early adopters of the model.

        Every physician I’ve talked with loathe the forced corporate model that healthcare is leading into. Corporations have failed big in many other verticals, just take a look at the recent economic catastrophe that they recently caused.

        When I bring up the subject of ACOs they reply: “Didn’t we try that already?”. Well, if ACOs try to replicate HMOs then the answer would be: “Yes”.

        The believers of ACOs claim that they are radically different than HMOs. Let’s wait and see.

        Bottom line, ACOs are being touted as to help improve healthcare; the question is: “How?”.

        What is true is that ACOs are being put in place to save money, which of itself is a noble cause considering that we have the most wasteful healthcare system in the world. Will “saving money” improve or worsen our healthcare delivery systems. It could go either way or both at the same time; who knows?

        The defenders of ACOs are using “sophism” to justify the “improving healthcare” slogan. They really have no evidence but instead a lot of opinions.

        Healthcare organizations know that they need substantial data that is not being collected in order to perform Population Health Management. PHM is one of the core premises to achieving the results that an ACO pursues, so they say. The problem is that healthcare organizations are nowhere near to being able to collect the data that will be required.

        To collect this data they would depend on the clinicians doing their part. Clinicians historically have never been flexible contributors in the adoption of information technology; why would they become different with an ACO.

        Going back to Margalit’s regarding corporate control, the reasons physicians go to this model are because of the following:

        - Financial difficulties on maintaining a private practice on their own
        - The guarantee of patients due to the marketing muscle of these organizations
        - Protection against malpractice defense costs
        - Inability to compete in the shared market

        So, let’s wait and see what comes out of the ACOs.

        As far as I’m concerned the best healthcare is the personalized one. Let’s have fun experimenting and then maybe we can go back to this model?

        Michael Planchart

  • Scott M Stallings

    I see a future if ACO’s become a reality, where all the organizations will be competing for the healthy patients and dumping the obese, the smokers, and anyone with chronic, progressive disease states. If my livelihood us going to be tied to outcomes, where is the motivation to keep these high utilizers of healthcare in my panel of patients? The obvious choice is to “stack” one’s panel with the healthiest patients you can find and drop the ones that will end up costing us. Those who care for thr sickest patients will have worse outcomes snd will be financially penalized for not meeting quality benchmarks.

  • doc99

    I hear “Accountable Care” but I’m thinking “Accountant Care.”

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