Accountable Care Organizations 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 2010 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, 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," he said.
A study by the California HealthCare Foundation says large, well-organized, multi-specialty practices are poised to take healthcare costs and quality to a new level through ACOs.
The study compared the costs and quality of care delivered to fee-for-service Medicare beneficiaries in 22 healthcare markets by physicians in small group practices to those in multi-specialty groups of 250 to 13,000 physicians.
The study revealed that large, multi-specialty group practices improved the quality of care by 5 percent to 15 percent with a 3.6 percent ($272) lower annual cost per patient. While the Medicare cost savings were relatively small, the study found that if all physicians performed at this level, the Medicare program could yield $15 billion per year in savings.
The findings support the argument that large, multi-specialty group practices with infrastructure already in place are well positioned to serve as ACOs
William Weeks, MD, of the Dartmouth Institute for Health Policy and Clinical Practice and lead researcher of the study, said, "Given where healthcare is headed with healthcare reform, it makes sense that large group practices begin to participate in accountable care models."
On a smaller scale, patient-centered medical homes are gaining momentum and could lay the foundation for ACOs, according to said Matt Adamson, vice president of medical home initiatives for MEDecision, a Wayne, Pa.-based provider of collaborative healthcare management solutions.
“You can have a medical home without an ACO, but you can’t have an ACO without a medical home,” he said.
One California medical group achieved PCMH status from the National Committee for Quality Assurance this year. The St. Joseph Heritage Medical Group concluded its yearlong journey in March.
St. Joseph officials said they decided to seek medical home status after the topic was featured in professional journals and publications and backed by primary care in general.
Officials said they weren’t yet sure of the financial implications, but have seen more efficient, coordinated and cost-effective care since the transition. They also believe the PCMH status is a selling point for patients.