Opinion- ACOs Good for Health Care System

An ACO -- "accountable care organization" -- is a group of physicians in the same organization who provide most or all of your care, but their focus is very much on the patient, delivering a new kind of team-based approach that really tries to put you, the patient, first.

For the doctors, it's a new way of structuring their practice to deliver better value and better quality of care to align with another new medical buzzword: patient-centered medical home. For the patient, it means that finally someone is accountable for providing you with convenient, coordinated health care and for helping keep you in good health. For health plans and for the government, which covers Medicaid and Medicare patients, it also means a way to transform reimbursement -- based on quality of care, not volume of care -- and reduce costs by keeping people well.

In an ACO, primary-care physicians take the lead, and when you need a specialist, you go to one within the ACO. The idea is to improve care and lower costs. Hmm, better care and lower cost sounds like two competing ideas. But the evidence suggests otherwise.

Here's the arguments for ACOs: coordinated groups of physicians get to know one another and their patients better. They communicate more easily, behave like a team and are more disposed to maximizing information technology. Knowing patients better will lead to fewer mistakes and incidences of overtreatment.

How do they differ from health maintenance organizations?

In an ACO the "accountability" rests with the physician practice or health care provider -- not the insurance company. Savings is achieved by rewarding providers for efficiency and better quality care. The model is also flexible enough to let physicians adapt and localize the kind of care they provide based on the needs of their own communities.

But the big difference is that in the HMO era there was little use of data to ensure that the system was performing to the benefit of the patient. An important requirement for ACOs is to capture and analyze data. Data will do for doctors' minds what X-ray has done for their vision -- allowing them to see things in new ways.

Will consumers embrace ACOs? What if they don't like an ACO specialist? How is an ACO set up to reap the incentives provided by Centers for Medicare & Medicaid Services? How do ACOs change competitive dynamics?

Over time, answers to these questions will surface as more voices are heard in the debate about how our health care system should be overhauled.

ACOs may also be the catalyst that unleashes information technology's full potential in health care where, historically, it has been a chronic underachiever. In a health care system dominated by ACOs, IT wouldn't have as many boundaries to cross as it does today with predominantly independent providers. Maybe it really is finally time to put the patient first.

Disclosure: Dr. Paul Grundy, an M.D., is IBM's global director of health care transformation.

-From “Opinion: Just What the Health Care System Ordered?” by Paul Grundy, MD., aol news, http://www.aolnews.com/opinion/article/opinion-acos-aim-to-lower-costs-and-improve-quality-of-health-care/19660480, retrieved 10/12/10. Cited in/linked from HEALTH CARE WEEKLY UPDATE, Barbara Roop & John Goodson, Health Care for Massachusetts, October 08, 2010.

 

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