Accountable Care Organizations – or ACOs – may not ultimately keep that name, but experts say the concept of organizing providers and payers into a network striving for higher quality and more efficient care is destined to become a reality fairly soon.
At the recent National Accountable Care Organization Summit in Washington, D.C., healthcare officials agreed that the current form of fee-for-service healthcare has played itself out under the crushing escalation of healthcare costs – and they said ACOs are the new way to go.
Steven Lieberman of Lieberman Consulting, Inc., a visiting scholar with the Engelberg Center at the Brookings Institution who has had experience over the last few years working on five pilot ACOs, is optimistic that they will take hold.
"I think that ACOs have hopefully hit the right balance of having a core set of key features but allowing for enormous variation at local sites," he told attendees of the summit.
"ACOs should become a pathway to begin a fundamental shift from fee-for-service and its fragmented services and perverse payment methods to aligned incentives that focus on population health and accountable care," Lieberman said.
Mark McClellan, MD, former administrator of the Centers for Medicare & Medicaid Services and currently affiliated with the Engelberg Center, said healthcare costs are making change an urgent matter.
McLellan said ACOs are mandated under the new healthcare reform law, but the definitions are vague. He expects that ACOs will be better defined through a host of yet-to-be-enacted regulations.
"Real reform happens at the local level, not in Washington," he said. "It will take real leadership to get critical mass."
Paul Katz, CEO of Intelligent Healthcare, LLC, in Santa Monica, Calif., said launching an ACO doesn't require much more than a disease registry and good data.
"The devil is in the data," he said. "You've got to get the data right from day one."
Eric Nielsen, MD, chief medical officer of the Greater Rochester (N.Y.) Independent Practice Association, said ACOs should include a way to secure data, well-developed guidelines for care and a way of monitoring performance according to those guidelines.
A basic electronic health record is a good start, according to Mike Cracovaner, chief executive officer of New Pueblo Medicine in Tucson, Ariz.
"All healthcare is local," he said. The difference between today and care improvement efforts in the 1990s is the electronic health record allows an easier way to monitor care, he noted.
If car dealerships can keep track of your car's upcoming maintenance requirements, "why can't we do that with healthcare?" he asked.