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ACOs can be driv­ing force in health sys­tems de­liv­er­ing qual­ity care, low costs

Modern Healthcare - - Front Page - Dr. Don­ald Ber­wick Dr. Don­ald Ber­wick is the ad­min­is­tra­tor of the CMS.

ACOs can be a driv­ing force for change, Ber­wick says

Edi­tor’s note: The fol­low­ing com­men­tary first ap­peared ex­clu­sively on­line at Mod­ern Health­care.com on May 17. It’s reprinted here for the ben­e­fit of our print sub­scribers. For more news, com­men­tary and in­for­ma­tion about ac­count­able care or­ga­ni­za­tions, please visit mod­ern­health­care.com/ACOs.

Amer­i­can health­care is at a cross­roads. Thanks to the Pa­tient Pro­tec­tion and Affordable Care Act, we are now well en route to as­sur­ing that all Amer­i­cans have the peace of mind that comes with ac­cess to health­care in­surance. Thanks to the new law, in­surance com­pa­nies won’t be able to deny cov­er­age based on pre-ex­ist­ing con­di­tions, se­niors will have ac­cess to im­por­tant preven­tive care and health in­surance will be­come affordable through “ex­changes” to peo­ple who other­wise couldn’t af­ford it.

But bet­ter cov­er­age isn’t enough. We also need bet­ter care. The rea­son is sim­ple: In its cur­rent form, Amer­i­can health­care is not sus­tain­able, ei­ther for many of the peo­ple who al­ready have in­surance or for the tens of mil­lions who now will be newly cov­ered. It is too of­ten frag­mented, un­even in its qual­ity and un­safe for pa­tients, all of which raises costs and de­grades care at the same time.

I am ab­so­lutely cer­tain that we can have what we want and need—bet­ter care, bet­ter health and lower costs—all at the same time. But we can have that only if we are will­ing to im­prove the health­care sys­tem, it­self—only if we are will­ing to change the way we de­liver care. If we are will­ing, then the Affordable Care Act can help. Be­cause it doesn’t just ex­tend cov­er­age and pro­vide new routes to health in­surance; it also gives our nation new tools for im­prov­ing the care sys­tem.

One of those im­por­tant new tools is the so-called ac­count­able care or­ga­ni­za­tion. The idea of the ACO is to en­cour­age and sup­port physi­cians, hos­pi­tals and other providers to lower costs by pro­vid­ing bet­ter qual­ity care, and to re­ward them for suc­cess by al­low­ing them to share in the re­sult­ing sav­ings. ACOs are part of an im­por­tant agenda of change: to shift Amer­i­can health­care from a sys­tem based on the vol­ume of care (the more you do, the more you get paid) to one based on the re­sults of care (the bet­ter you do for pa­tients, the more you get paid).

ACOs won’t just be a new way to pay for care; they will be a new and bet­ter way to de­liver care.

In March, the CMS pub­lished its ini­tial, pro­posed rule on how to im­ple­ment ACOs, and we are now in the midst of a pub­lic com­ment pe­riod. We’ve heard from hos­pi­tals and physi­cian groups about their con­cerns re­lated to the need for cap­i­tal, shared sav­ings and re­duced com­plex­ity. We also know con­sumers want choice and qual­ity. We are lis­ten­ing to these com­ments, tak­ing them se­ri­ously and work­ing to im­prove the pro­posal into an even bet­ter fi­nal rule.

That’s a chal­leng­ing job, be­cause the ground rules for ACOs have to strike sev­eral care­ful bal­ances. We want to give providers in­cen­tives to achieve sav­ings and tools to help co­or­di­nate and im­prove care, but we also want to make sure they don’t stint on care or with­hold care when it’s needed. We want to make sure pa­tients get far bet­ter co­or­di­nated care, but we don’t want to bur­den ACOs with rafts of cum­ber­some reg­u­la­tions. We want ACOs to form close re­la­tion­ships be­tween pri­mary-care providers and spe­cial­ists, but the Affordable Care Act re­quires that pa­tients in ACOs re­tain the right to see any Medi­care provider they want. ACOs need data, but pa­tients need their pri­vacy pro­tected. The CMS and our part­ner agen­cies have been hold­ing feed­back ses­sions and so­lic­it­ing in­put from all stake­hold­ers—physi­cians, hos­pi­tals, pa­tient ad­vo­cates and many more—on the pro­posed rule, so we can get these bal­ances right.

Mean­while, we’re mov­ing ahead quickly. Even as we con­tinue to seek in­put on the ACO pro­posal, we are launch­ing sev­eral ini­tia­tives to al­low us to hit the ground run­ning. Providers who are al­ready ahead of the pack in co­or­di­nated care will have an ac­cel­er­ated path­way to be­com­ing ACOs even be­fore the new reg­u­la­tions go into ef­fect, thanks to a Pi­o­neer ACO pro­gram just an­nounced by the CMS’ new In­no­va­tion Cen­ter. We are seek­ing com­ments on a pro­posal to pro­vide some up­front pay­ments to providers who want to form ACOs but lack ac­cess to cap­i­tal to in­vest in new in­fra­struc­tures and staff to co­or­di­nate care. And the In­no­va­tion Cen­ter will soon launch a pro­gram of in­struc­tion and tech­ni­cal sup­port to help new­com­ers who want to form ACOs learn how to do so.

As we nav­i­gate to­ward a fi­nal ver­sion of the ACO de­sign, we are im­pressed by the level of en­gage­ment on this topic; peo­ple sense that we are at the thresh­old of an im­por­tant and pro­duc­tive change. And, as dif­fi­cult as it is, com­ing up with a work­able, promis­ing frame­work for ACOs based on stake­holder feed­back will be well worth the ef­fort, be­cause, if im­ple­mented cor­rectly, ACOs will be a driv­ing force in im­prov­ing health and low­er­ing costs. They will be one key to sus­tain­able, high-qual­ity care for all of us.

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