Barbara Duffy
I have been reading a bit about Accountable Care Organizations lately – after all how can you miss it? There are some great ideas and plenty of potential being tossed around. Concepts being discussed in the literature include:
– Coordination of a wide variety of participants in the patient’s health care into vertically integrated networks,
– The need for evidence-based guidelines for physician practice,
– The need for technology to coordinate and provide appropriate options of care,
– Governance structures that include physicians,
– Combining competitive forces to enable improved negotiations from vendors,
– Process management, process management, process management,
– Alignment, alignment, alignment. Integration, integration, integration,
– Looking at the entire continuum, working collaboratively, and giving up control to get control,
– Monitor and evaluate ongoing clinical performance and work flow,
– Determine how to obtain out-of-network care information before the claim hits,
– And of course – payment.
There is much more, but I am hoping we are not missing the entire other side of the equation. It is perhaps the most important one. What is going to compel the patient to participate in the ACO? What incentive do they have to leave long-term, trusting, and comfortable relationships with their four (or more) physicians? For some elderly patients, health care is as much a social event as a health maintenance necessity. How do we convince them to make the move to an ACO without implying the care they are currently receiving is not ‘good enough’?
I believe ACO’s have boundless potential to tip the balance back to all that is great, altruistic, and cost-effective about health care. However, I also believe we are going to need some marketing help to persuade a cautious public that ACO’s are not a money-making creation to ration care. We need to convince the public that technology and skills have advanced enough to improve the health of populations and the individual. As a result, ACO’s are a synergy of information and physician expertise that permits health care providers to promote health consistently, appropriately, and effectively to each patient and across the health care system.
BD