Can ACOs reinvent the American health care system?

The cost curve of American medicine continues to bend up. That is unsustainable. It must begin to bend downward.

Two recent headlines focus the problem:

New York Times, May 14, 2011: Health Insurers Making Record Profits as Many Postpone Care

And, CNN Money, May 11, 2011 reports “Your family’s healthcare costs $19,393.” That is for a family of four, which has a median income of $75,700  — before taxes.

Opportunity knocks, loudly. We can change our medical world now.

American medicine has been very successful. American medicine has been a dismal failure. Both statements are correct, depending on how one looks at it.

It is now our opportunity, indeed I say our professional responsibility, to preserve the best, and to scuttle the worst.

We can build a new medical world based less upon process, quantity, volume, and lucre, and more on quality, safety, speed, outcomes, and patient-centered efficiency.

In this new era of accountable care organizations (ACOs), keep your eyes on the prize.

And the prize is positive outcomes for the health of the mind, body, and spirit of the patient.

Keep healthy people healthy, vigorous, and confident; recognize and treat acute illness quickly and effectively; manage chronic illness efficiently; do not promote disease mongering, cyberchrondriasis, medical bankruptcy, or, what Nortin Hadler and Clifton Meador call “the worried well.”

Accountable Care Organizations may take many forms. I believe that physician leadership will be the key.

The three goals of an ACO are to:

  1. Increase perceived value of care
  2. Improve actual clinical outcomes
  3. Lower healthcare costs

If it saves money, the ACO gets to keep some of the savings. This truly is an exciting opportunity to do well by doing good.

With ACOs, the American healthcare non-system actually can and should be reinvented.


I recommend engaging and empowering communities to work with the healthcare sector in building ACOs for their common good.

The credo of The Lundberg Institute is: one patient; one physician; one moment; one decision; let it be a shared decision, informed by the best evidence, and considering cost.

Might ACOs make health community informed shared decision-making of the same sort possible, facilitated by participatory technologies and social media as recently suggested by Springgate and Brook in JAMA?

Exciting time. Be creative. Seize the moment. Save American pluralistic healthcare. It may be our last best chance.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit for more health policy news.

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