Observation Deck: Accountable care organizations: Will they stand the test of time?

Journalists love trends. They’re new and exciting, and they give us interesting things to write about. Right now, we love accountable care organizations, or ACOs. They’re all over the news – both the trade press and consumer press. But in fact, they’re really just in their infancy, and it’s too early to tell whether they will remain part of the healthcare fabric beyond a year or two.

I’m going to hazard a (safe) guess here, and say that even if the term “ACO” becomes outdated, the concepts behind it won’t. Look, even though we don’t talk a lot about HMOs anymore, the fundamental concept – capitation – remains a viable approach to healthcare. What was flawed was the execution, and the emphasis on cost rather than quality. But the concept of holding a physician (or team of physicians and other caregivers) responsible – financially and clinically – for a person’s care over an extended period of time still makes a lot of sense today.

So, what about ACOs? What are the concepts that are likely to withstand the test of time, even if the term itself does not? That’s easy.
Forcing doctors and hospitals to coordinate a person’s care, regardless of whether that care is delivered in a hospital, an ambulatory care facility or home. That makes sense, doesn’t it? After all, working in silos leads to poor communication, repetitive (and wasted) care, a sense of alienation on the part of the patient, and perhaps worst of all, missed opportunities for smart caregivers to share their expertise for the good of the patient.

Define processes to promote evidence-based medicine. I think most of the clinical community has moved beyond their objections to what used to be called “cookbook medicine.” Does anyone really believe that doctors – who are, after all, humans – can’t stand to benefit from well-researched and well-documented outcomes research? Yes, there’s an art to medicine, and that fact can’t be lost in the shuffle. But doctors, particularly young ones, are learning how to integrate evidence-based medicine with their gut feelings, intuition and experience.

Meet “patient-centeredness criteria.” True, this is easier said than done. It takes time to draw up individual care plans. Under today’s reimbursement system, that’s time that caregivers don’t get paid for. But will anyone argue that providing patient-centered care will hurt patients? Let’s hope the powers-that-be can craft a reimbursement system that will compensate and reward caregivers for drawing up patient-centered care plans.

In fact, that’s the biggest wild card: Can the federal government pull this off? Can it change reimbursement mechanisms to transform today’s volume-driven healthcare system to tomorrow’s quality-driven one, a system built on promoting and preserving people’s well-being?

Maybe. Maybe not. But the bold experiment has begun. And if the execution is flawed, the fundamental principles of ACOs are sound, and they will survive. They will form part of the basis of tomorrow’s healthcare delivery system. At least, I hope so, because to continue down today’s path may very well bankrupt the system.

Mark Thill About Mark Thill

Mark Thill is the Editor of The Journal of Healthcare Contracting and has been reporting on healthcare supply chain issues since 1985. He is a graduate of Dominican University in River Forest, Ill., and he received a master's degree in journalism from Northwestern University in Evanston, Ill.

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