Time to break down the barriers getting in the way of ACO success

[Previously published by Hospital Impact]

“The goal of an ACO is to coordinate high-quality care in order to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors,” according to the Centers for Medicare & Medicaid Services.

This is clearly a critically important goal to achieve if we are to honor our patients, keep them safe, and best position them to achieve their optimal health outcomes.

In a 2010 post for Hospital Impact, I shared my concerns regarding the accountable care organization model based on the experience of Harvard Pilgrim Health Care and its PHO risk sharing/revenue sharing model in the 1990s.

As that post detailed, the problem was that provider organizations quickly realized that the financial incentives were not optimally aligned with working to reduce medical costs with the provider organization’s hopes of sharing a percentage of some potential savings. Instead, they were better aligned with the provider organizations continuing to leverage existing and new services, expensive procedures, technology, efficiency improvements focused on boosting productivity, and other revenue-generating activities.

And unfortunately, these very same challenges remain true today with the current state of the ACO model.

As Robert Murray, president of the consulting firm Global Health Payment, tells Kaiser Health News, large, deep-pocketed providers that most commonly form ACOs “are unlikely to make aggressive attempts to control costs because the hospital and specialists are still being reimbursed under traditional fee-for-service payment model.”

And as Ray R. Lewis shared in a post to the Robert Wood Johnson Foundation LinkedIn Leadership Forum, even in Minnesota where the healthcare market tends to be ahead of the curve: “fee-for-service payment still dominates in Minnesota, with only a small portion of revenues tied to ACO arrangements. Two-thirds of surveyed providers indicated that 10 percent or less of their organization’s revenue was at risk; a quarter of respondents expected to see that figure rise to 30 percent by 2020.”

Thus, even in an “advanced” market we are still four years away from less than a third of healthcare revenues being tied to keeping patients healthy.

So what does this tell us?
» Does this tell us that the ACO concept is wrong?
» Does this tell us that we should stop trying to “coordinate high quality care in order to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors”?

Absolutely not. There remain positive flames we must continue to fan within the ACO model.

According to Richard Barasch (in the same KHN report), within ACOs: “They [physicians] work hard to get their quality scores where they think they should be—and when they’re not, the doctors are very, very chagrined. Hospitalizations in 2014 decreased on average by 11 percent for beneficiaries with chronic obstructive pulmonary disease, for example, and by 8 percent for those with congestive heart failure.”

So let’s focus on the positive aspects of the ACO and the mission we must fulfill:
» The aim of the ACO is correct.
» There is much energy, passion and momentum in achieving this aim.
» There is much history we can learn from to mitigate our missteps as we proceed on this journey.
» We can measure the impact of the ACO.
» There are parent partners and patient and family advisers throughout the nation ready to help.
» The healthcare industry is beginning to embrace relationship-centered and compassionate care and creating systems to ensure all people and organizations throughout the healthcare system are whole and well-positioned to be of service and care for one another.
» There is a great need for us to get this right as efficiently and effectively as possible. It is not simply a matter of financial impact; it is a matter of our families, our friends, our neighbors and our communities being harmed by the brokenness of the current system we have created. The longer we wait to evolve and improve the system, the more harm is being done to those we most care about.

Now we must move beyond politics and ego. We must move out of our unproductive entrenchments. We must transcend limited beliefs and thinking. We must call upon the servant leader within all of us and together and collaboratively break down the barriers to achieving the aim of the ACO, evolve the model and get it right … and honor all those we love.

We do not have four years. The damage will be (is) too great. Now is the time.

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