What Happened to Accountable Care Organizations?


The term “Accountable Care Organization” (ACO) first showed up at a 2006 conference and was part of the Affordable Care Act (“Obamacare”) when it was enacted. For a while, it looked as if it was going to become a dominant model for health care delivery.

Wikipedia delineates three core principles, for an ACO:

  1. Provider-led organizations with a strong base of primary care that are collectively accountable for quality and total per capita costs across the full continuum of care for a population of patients;
  2. Payments linked to quality improvements that also reduce overall costs; and,
  3. Reliable and progressively more sophisticated performance measurement, to support improvement and provide confidence that savings are achieved through improvements in care.

For those of us in non-clinical home care, such as Support For Home, implicit within these principles are the elements of a new approach to health care that would be extremely beneficial to patients and providers.

First, the “organization” to which ACO ties does not have to be a single business or corporation. In fact, most of us expected the formation of ACOs involving a complex, integrated set of organizations, spanning the entire health care delivery system, from clinical to non-clinical. Sadly, many ACOs were formed by single businesses, to protect or enlarge their own interests. Tough statement, but … There are, we are delighted to note, a few exceptions, where ACOs have been formed with the right approach, focused on integrating providers across all relevant clinical and non-clinical disciplines.

Second, we thought ACOs would change the funding model, opening up Medicare funding to non-clinical health care providers. That would reduce the extreme pain faced by families paying for long-term care privately. It would also support the articulated goal of reducing the overall cost of health care delivery. That opening up has not happened.

Thankfully, the third element, performance measurement, has shown more results and more promise over the past few years. Metrics are becoming more and more important, around both health care outcomes and the cost of health care delivery.

All in all, however, the inclusion of ACOs in the Affordable Care Act has not been as beneficial as many of us had hoped. Part of the problem is that forming ACOs and making them work is extremely difficult. We are aware of only one successful, on-going ACO in northern California – Golden Life Healthcare. How can that possibly be the case, when 4-5 years ago ACOs were the promise of the future? CMS (Medicare) needs to take a thorough (but quick) look at what needs to be changed in order for the promise of ACOs to become a reality, in the future.

Your thoughts?

Best wishes. Bert

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