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

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.