Even before the release of the official rules for Accountable Care Organizations (ACOs) by CMS, there were rumblings of displeasure with the form and format that was being laid out.  Once official, the rumblings became more of a storm of protest from some of the largest integrated delivery networks (IDNs) in the country.  Most notable, the Mayo Clinic, Cleveland Clinic, Intermountain Healthcare and Geisinger Health System were very vocal in their opposition on various complexities, anti-trust and other grounds.  All valid points in my opinion, but is it really just tilting at windmills?

There is no argument that health care costs are spiraling out of control and that current growth rates are untenable in the long term.  A shift of the financial burden has already occurring by employers, and by extension patients, being forced to bear higher premiums and tighter restrictions.  From this new economic reality came the concept of accountable care organizations (ACOs).  At its core, an ACO is a care delivery system where providers are compensated on the care they provide a defined patient population through a series of quality and performance measures and cost benchmarks.  (This is not meant to open a discussion about capitation, HMOs, or any other previous attempt at managing health care costs.  And, for the record, I do think the concept behind ACOs has legs.)

Those legs, however do not necessarily include the ACO in its current form, but rather the concepts of creating long term patient relationships (via patient activation) as a competitive tool and risk sharing as a reimbursement inevitability.  And, if you read the comments by the notable ACO dissenters listed above, you can see that they also agree that the concept is valid and are in fact taking steps to adapt to the new realities of healthcare delivery.

Patient activation is the concept of getting patients engaged and active in managing their own health. Realistically, this can only be accomplished through providing a coordinated set of capabilities and services that draws the patient in and not only continuously provides information, but anticipates that future needs of the patient.  Creating the role of trusted health advisor that is top of mind with patients any time they require healthcare related information is the ultimate goal.  If you look at life from a healthcare perspective, it is a series of care events punctuated by (hopefully) long periods of relatively good health.  Contact with the patient during these periods of good health is crucial to sustaining a long term relationship.  Realistically, this can only be accomplished through the use of information technology tools, notably a patient portal that integrates into an organization’s clinical, education, and messaging systems.

The banking industry is useful analogy.  The more integrated you can make someone’s financial life the harder it will be for that person to move somewhere else to get the same range of services, thus creating a long term source of service utilization and revenue.  Plus it will provide a better overall financial picture for the customer to make better informed decisions.

Integration to multiple systems highlights the challenges of moving into a risk sharing model for patient populations.  For an organization to go at risk, that is confidently state that they can treat a given patient population for a set amount of money, requires tremendous effort in collecting, tracking, and reporting on key quality measures, strong communication and care work flows based on generally accepted best practices – for multiple types of patients across multiple care environments (IP, OP and LTC as examples - and constant monitoring and feedback of patient information, utilization, and messaging.  This requires a huge investment in time, people and capital across an organization, but done right, will yield long term benefits and returns.

So are ACOs really dead?  No.  Much like any new concept there are going to be multiple variations and models that will need to be played out over time to see what works.  With that being said, any healthcare organization that does not think that they will be held more accountable for the quality and type of care they deliver and the meaningful impact they make on the patients they serve are in for a rude shock.  Will this require more work and investment by HCOs?  Yes.  With the ultimate payoff be patient loyalty and, in turn, financial stability?  Absolutely.  The question that remains is how long can healthcare organizations wait to secure their future?  I say sooner rather than later.

--Jim McGregor, Sr. eHealth Strategist

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