A recent report published by the Institute for Health Technology Transformation gave some interesting insight into accountable care organizations (ACOs). Among sections focusing on the origins of the ACO concept and their current state, the report detailed 10 basic things you need to know about ACOs.
1. A physician's role will change dramatically. "The economics of patient-centered care will create significant financial incentives for doctors to do more to coordinate care - most importantly, increase collaboration with other medical professionals," the report read. And in addition, this collaboration, according to the report, will occur within the confines of firm, evidenced-based medicine. "...Physicians will be incented to work in patient-centered, evidence-based practices, interfacing with other physicians and care providers to optimize the patient's health at the lowest possible cost."
2. Patients must be engaged in their care. The report stated ACOs build a competitive edge by engaging patients in the delivery of their healthcare. "ACO models propose patient engagement in decision making that requires consideration not only of the best scientific evidence concerning medical treatment, but also the opportunity for patients and their families to assess prospective treatment approaches in light of their own values and convictions." ACOs promote this type of patient engagement as well as possession of basic knowledge for the patients. This enables them to maintain good health, all while avoiding preventable medical conditions and knowing how to manage existing conditions. And, eventually, this will cause accountability to extend beyond the ACO and into the general public.
3. ACOs will create winners and losers among providers. The report cited Harvard business professor Clayton Christensen and said ACO models can be thought of as disruptive business models. "These disruptive models will need to create alignment of interests of the individual doctor and the team, and all will share accountability when patient care goals are not met." Therefore, for ACOs to be successful and sustainable, they must compete for consumers. "Successful ACOs must give consumers a value proposition that is competitive locally, nationally and globally," the report stated. "Providers that are not accountable and transparent will 'lose,' and those that meet patient needs and improve care will 'win.'"
[See also: ACOs adopting different payment approaches under PPACA, says report.]
4. ACOs are a team sport. According to the report, today’s siloed patient care approach won't function in a world of accountable care. In fact, an effective transition to an environment that’s more patient-centered and information-rich requires leaders to become informed consumers of the products of improvement science. "These new approaches will change the way the physicians interact with patients, payers and other clinicians," the report read. "While there will be examples of ACOs established by physicians in isolation from hospitals and health plans, this may not be the ideal approach. The reality is that physicians, hospitals, health plans, and many other healthcare stakeholders each bring unique skills and experiences to help deliver accountable care."
5. Transparency will empower consumers and motivate providers. The report makes clear it’s not possible to have accountable care without having at least one party that the healthcare system is accountable to. "In the case of ACOs, the assumed beneficiary has traditionally been the federal government," the report stated. "Since accountable care models are supposed to save money by doing a better job of coordinating care and making wise treatment decisions, the government (and thus the taxpayer) is better off as a result." But, this view doesn’t reveal the whole story, said the report. In fact, it's the consumer that stands to benefit the most from regulations that improve transparency. "Since providers differ widely on cost and quality, widespread adoption of quality measures is likely to improve patient access to this information."
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6. ACOs will require health system redesign. According to the report, this redesign will be more than simply tinkering with business models. "ACOs have become synonymous with the Medicare Shared Savings/Pioneer Programs," it said. "However, this is a serious misnomer. These programs have served as models for increasing accountability and integration within the health system, but do no represent the end goal of health reform." Instead, ACOs seek to align patient and physician incentives and provide sustainable outcomes-based compensation systems. "To that end, the accountable care program is another step on the road to integrated patient-centered care... ACOs are a catalyst for dramatic transformation in the way patient care is delivered in the United States."
7. ACOs must be dynamic learning organizations. "High performing ACOs tend to be learning organizations, where the workforce excels at creating and sharing knowledge," read the report. "This exists where there is a supportive learning environment, concrete learning processes and practices and leadership behavior that reinforces and supports learning." It's no surprise this type of environment engages the workforce, which then leads to successful accountable care. This includes consistent focus on the customer, process and quality improvement, improved efficiency and, in the end, better health outcomes and experiences for the patients.
[See also: ACOs don't have to be daunting, according to experts.]
8. An ounce of prevention is worth a pound of cure - and costs a lot less. According to the report, health systems delivering accountable care could change the way the U.S. health care system works. For example, focus should shift from episodic, acute care provision to wellness and prevention. "This can be achieved through patient engagement and empowerment, improved chronic disease management processes, effective predictive modeling and population health management," said the report. It also added providers need to "be in the business of health, and not just in the sickness business. Emphasis should be placed on wellness and prevention programs, which have shown to improve health outcomes when properly administered."
9. Expect a significant change in transitions of site care and delivery mechanisms. Remote and virtual care will become the norm, said the report. "The value-based care expected of ACOs is a complete diversion from the fee-for-service system, which encourages higher volume of patient visits." As ACOs seek to keep patients healthier, the report stated we’ll likely see a centrifugal shift from hospitals to ambulatory sites. "Additionally, increased utilization of remote patient technologies is feasible," it said.
10. Primary care should be a major focus in the ACO environment. "Because of the potential for improving health and avoiding costly complications of chronic diseases, many of the ACO performance measures relate to performance in primary care," the report read. Additionally, it's recognized that increased investment in primary care is needed to slow the overall rate of growth in healthcare spending. "Together, this supports that it will be critical for ACOs to have a strong foundation of high-performing primary care and to practice evidence-based medicine."
To download the full report, click here.
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