This piece came on the air on the way home from work -- very good wrap up of the idea and practice (at least one) of the ACO. They hit some of the most important areas such as aligning incentives for coordinated care, chronic disease management and avoiding hospital re-admissions (via follow-ups):
"We had to get the patients comfortable that they were going to receive whatever care they needed," he says. "If they needed orthopedic surgery, we're going to get you to the orthopedist."
In fact, the doctors at Redlands decided there were some patients they wanted to see much more often. Those with multiple chronic illnesses come in almost monthly, even when they're doing well. Hospitals also had to get onboard. The clinic offered the local hospital financial incentives for getting patients out quickly and safely and avoiding unnecessary and costly re-admissions.
Sandee Derryberry, the practice's executive director, says the clinic focuses — almost obsessively — on helping patients make a smooth transition out of the hospital.
The "coordination" model has had successes elsewhere, for example this New Yorker article (focused on the widely reported excesses in McAllen, Tx) spoke with health leaders in Grand Junction, Co:
Problems went down. Quality went up.
Then, in 2004, the doctors’ group and the local H.M.O. jointly created a regional information network—a community-wide electronic-record system that shared office notes, test results, and hospital data for patients across the area. Again, problems went down. Quality went up. And costs ended up lower than just about anywhere else in the United States.
Dr. Elliot Fisher, quoted in the New Yorker on the topic of Accountable Care Organizations, asks in the NPR piece about alignment of incentives:
Despite the clinic's lower costs, however, private insurers continue to raise premiums. And Terrazas says that threatens to unravel the tacit agreement he and his colleagues have made with their patients.
Dr. Elliot Fisher is a leading health policy researcher at Dartmouth who has closely studied the ACO concept. He says greater savings will come if the model spreads. "One question is: Will all payers — Medicare, Medicaid and the private payers — adopt the same reimbursement model and same aligned incentives?" Fisher asks.
That remains to be seen. Clearly we cannot overlook the money trail. If costs decrease, someone is making less money:
...the U.S. health care system is littered with pilot projects and research studies that map out how to reduce medical spending, but implementing them requires tough political and business decisions.
"If you’re going to cut costs, the spending pie has to shrink. And that means somebody is going to make a lot less money. And there’s no discussion about who that’s going to be," Brown says. "Who’s going to take that hit?"
Read or listen to the entire piece at NPR.org.
The New Yorker (or Newsweek) article covers more than just McAllen, Tx and is a very good read. So good that President Obama made it required reading for his staff and an example of an area U.S. healthcare needed to improve.
