It's no secret there are many in the healthcare community who feel the move toward accountable care organizations (ACOs), is simply a flavor of the decade whose taste will sour and will inevitably take a place on the scrap heap of failed system reforms alongside its first cousin the HMO.
Bloggers have devoted countless ones and zeros to their naysaying for a variety of different reasons including that ACOs will eventually be lured into creating profits by denying care to those who critically need it (the same activity that doomed broad-based HMOs); and that many smaller practices and sub-specialty doctors, who have based their very financial livelihood on the fee-for-service model won't be willing to accept any other form of compensation for their services.
The practice is still very young and so many of the ACO initiatives still have not collected sufficient data to suggest whether they will work or not. That said, it should also be noted that while many of the basic tenets of ACOs, such as the reliance on electronic medical records and dedicated care coordinators, are common to virtually all ACOs, it is also fair to say that if you have seen one ACO, you've seen one ACO.
And that is why there should be some encouragement if you examine three years of data on a 750 patient pilot ACO between Aetna and NovaHealth in Portland, Maine, reported recently in Health Affairs. The pilot program, Aetna's longest running ACO pilot showed these Medicare Advantage members saw significant care quality improvements in a number of areas. Among them: lower hospital admissions, shorter hospital, 30-day hospital readmissions were down, as were the total per-member, per-month costs.
According to Joe Agostini, MD, senior medical director with Aetna, who worked with NovaHealth on the pilot program, the insurer takes the approach that its ACO relationships with will naturally evolve over time. This evolution will take into account the specific nature of each in terms of how quickly the ACO will migrate from blended fee-for-service model to one that shares gains and eventually to the Holy Grail: one that shares both the gains from a program while also sharing the risk.
"They way we have structured it in most of these provider collaboration arrangements is in the beginning to have reasonable goals that we both can achieve, and then as both gain experience, continue to evolve that care management model and the financial model to move toward the ultimate goal of reimbursement that approximates the best population health model," Agostini said.
Thomas Claffey, MD, director at NovaHealth said the program has worked thus far due, in large measure, to the buy-in of all the care givers in the practice. "You need to get everybody in the organization used to the idea that it is a team approach to caring for the patients," he said. "The people who are the care managers are on the team with the doctors an they're there to help the doctors deliver a higher quality product to the patient."
Further, Claffey noted, there is the solid belief at NovaHealth that what they accomplished with 750 Medicare Advantage patients over three years, is both scalable and replicable to their broader patient population that numbers more than 62,000.
And while this may be only one ACO success story, there will surely be others in the years to come. There will also be failures, but that is to be expected as payers and insurers all look to find new ways of paying for care in today's care model petri dis. The need to fix our payment and care system is urgent, but with literally hundreds of similar pilot collaborations happening right now across the country, if only a handful of ACOs turn out to be successful and they prove to be replicable, then it will be a victory for us all.