The Chal­lenge and Op­por­tu­nity of Ac­count­able Care: In­sights from ACO Pioneers

Modern Healthcare - - THE WEEK IN HEALTHCARE -

The tran­si­tion from fee-for-ser­vice to a more “ac­count­able” health­care sys­tem seems in­evitable, es­pe­cially given the broad sup­port for value-based re­im­burse­ment among com­mer­cial pay­ers. Lead­ing provider or­ga­ni­za­tions, how­ever, are di­vided on the right re­sponse. They are ask­ing, how can health­care or­ga­ni­za­tions that were built on vol­ume quickly adapt to value-based re­im­burse­ment? The most widely em­braced an­swer so far has been the Ac­count­able Care Or­ga­ni­za­tion (ACO), which teams physi­cians and hos­pi­tals with com­mer­cial or gov­ern­ment pay­ers to de­liver co­or­di­nated, high-qual­ity care and share in the sav­ings. Crit­ics of the model sug­gest ACOS will pro­duce few sav­ings, forc­ing providers to take on more risk with­out the com­men­su­rate re­wards. Not sur­pris­ingly, many providers are tak­ing a wait-and-see ap­proach. Oth­ers, how­ever, have jumped in with both feet. “Not long ago, few providers were con­vinced that val­ue­based, in­te­grated, co­or­di­nated care was the right path but to­day the mar­ket has turned,” said Parie Garg, PH.D., a con­sul­tant with Oliver Wy­man’s health­care prac­tice. “Now it’s a ques­tion of en­abling peo­ple to get there.” Allscripts Chief Med­i­cal Of­fi­cers Doug Gen­tile, MD, and To­bias Samo, MD re­cently re­viewed the chal­lenge and op­por­tu­nity of de­vel­op­ing an ACO with Oliver Wy­man and six provider or­ga­ni­za­tions whose ex­pe­ri­ences mir­ror the broad spec­trum of de­bate: Two of the orig­i­nal 32 Medi­care Pioneer ACOS; the na­tion’s largest com­mer­cial ACO; a ma­jor IDN that is pur­su­ing its own ac­count­able care path; a large stand-alone hospi­tal that is test­ing the ACO wa­ters; and an in­de­pen­dent, mul­tispe­cialty physi­cian group that is wary of step­ping in. Their in­sights ad­dress­ing physi­cians, hos­pi­tals, pay­ers and pa­tients will help provider or­ga­ni­za­tions con­struct a com­mon cul­ture that sup­ports the cre­ation of value for ev­ery­one.

Not sur­pris­ingly, many providers are tak­ing a wait-and-see ap­proach. Oth­ers, how­ever, have jumped in with both feet.

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