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Statistics show healthcare costs have been growing at an unsustainable rate, reaching an estimated 17.3 percent of the Gross Domestic Product in 2009 according to the Centers for Medicare & Medicaid Services (CMS). This represents the largest one-year increase in history. CMS predicts that, left unchecked, costs will rise to 19.3 percent by 2019 - comprising almost one-fifth of the nation's GDP and nearly four times the 5.1 percent of GDP that healthcare consumed back in 1960.
At the same time, research and anecdotal reports continue to identify gaps and inequities in the quality of healthcare delivered in the U.S.
These trends - coupled with the millions of Americans still un- or underinsured - led to the recently adopted health reform legislation. Now, the challenge is to transform the national infrastructure from a volume- to a value-based model that better aligns the incentives and needs of all stakeholders. The goal is to provide more-coordinated, higher-quality healthcare more cost-effectively, while expanding access to services to an estimated 32 million Americans.
A Way to Meet the Challenge: ACOs
Accountable Care Organizations (ACOs) are designed to closely connect groups of providers who are willing and able to take responsibility for improving the overall health status, care efficiency and experience for a defined population of patients.
Critical components of the ACO model include:
- Person-centered health homes that deliver primary care and coordinate with other providers as patients move across the delivery system.
- New approaches to primary, specialty and hospital care to reward care coordination, efficiency and productivity.
- Tightly integrated relationships with specialists, ancillary providers and hospitals so they are similarly focused and aligned on achieving high-value outcomes.
- Provider/payer partnerships and reimbursement models that reward improved outcomes, rewarding value over volume.
- Population health information infrastructure, including health information exchanges, to enable care coordination across a designated population.
Patients continue to have great trust in their personal physicians. And the cornerstone of the ACO is a "healthy" hospital-physician-patient relationship that helps people become more knowledgeable about and involved in their health behaviors and medical care.
Thus, it is essential that ACOs address the frustration of doctors who feel squeezed by today's payment system, pressured to see more patients while at the same time burdened by increasing administrative requirements. ACOs should emphasize the benefits of the model, which will allow physicians to perform at the top of their licensure, trusting administration and non-clinical tasks to others while allowing physicians to spend more time developing treatment plans or discussing health status.
ACOs also need physicians to help design a system that is fair, inclusive and gets it right. Physicians should be the core of the ACO decision-making team, working with hospitals and other care providers to do what's best for people.
Engaging physicians to develop payment models so that those providing high-quality care that improves the population's health status are fairly compensated is also essential to the success of an ACO. Incentive structures need to reward the right outcomes by paying physicians fairly for preventive care, patient coaching and for helping coordinate care for those with chronic conditions.
Those pursuing the ACO model need to partner with physicians who want to help: Help fellow physicians and healthcare providers improve their own care delivery; help patients understand their responsibility to recognize and seek high-quality care, improve their health behaviors and comply with treatment plans; and help measure and publicly report performance in ways that make sense.
As a nation we all must work to rein in spiraling U.S. healthcare costs, expand access, promote wellness and improve the consistency of quality outcomes. We know we need to move from a disjointed, siloed "system" of delivery to one that is better coordinated and aligned to provide real value to patients, providers and payers alike. Successful ACOs that are truly accountable for maintaining the health of a population are a means of getting there.
 Richard Bankowitz is chief medical officer at Premier healthcare alliance, Charlotte, NC.
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