What is the right answer for ACOs?
Accountable Care Organizations (ACOs) were primarily established by The Centers for Medicare & Medicaid Services (CMS) to improve the coordination and care of patients to cut down on wasted spend, hold providers to a higher quality standard and achieve higher positive outcomes for patients. ACOs provide an interesting free market potential by holding providers accountable for the quality of the care given to each patient while also focusing on reducing costs without sacrificing the quality of treatment(s). While the concept of having a higher quality healthcare system with lower potential expense sounds phenomenal, there are quite a few factors that I believe make this approach very difficult from a Federal Level…
1. With CMS having a track record with implementing ACOs, why is the current Medicare system in debt? If ACOs are intended to lead to higher quality and better outcomes, the current model that CMS has been using does not appear to be driving down healthcare cost, in fact it is doing the exact opposite. If the Federal government plans to birth ACO models under PPACA from the current plan in force with CMS, I do not believe we will be able to accomplish a real ACO healthcare platform with the intention to provide higher quality of care at a lower cost.
2. How are we going to adequately set-up a system with metrics to track providers and hold them accountable? In theory the concept of ACOs are a win-win for all parties involved, but the work and resources needed to effectively drive these programs is extensive. It is important that fair standards are set for each specialty in medicine where by each case can be analyzed to determine an acceptable treatment path for various scenarios surrounding an individual’s healthcare needs.
3. Education to consumers of healthcare (all of us!). While it is easy to place blame on providers and hospitals, I think it is extremely important to have resources and education that is easily accessible to consumers of healthcare. We make purchasing decisions on price and quality all throughout our lives, why is healthcare so confusing? This is very concerning when you consider that the majority of America has very little resources to take control and understand their personal healthcare needs.
There is no doubt that this is a very complicated issue with multiple opinions. I feel that establishing ACOs that could effectively hold providers accountable while delivering high quality standards with lower costs would be a dream come true. I believe it is going to take a number of years to enact these programs in a way that provides real/measurable results at a Federal Level. The Federal Government should task each state, independently, to develop an efficient ACO model with rewards based upon measurable results. Developing models that are home grown, within each state, will provide great insight into the variances in healthcare cost nationwide and lay the appropriate foundation to build a solid ACO model for the entire country.
We do not have to wait on the government to build our own ACO models. Employers now have the ability to provide an ACO model within their group health plan! Transparent Health provides a solution to all aspects of a health plan in driving down cost while incentivizing employees to make price and quality decisions on their healthcare needs. Prior to making decisions on price and quality, employees are provided with resources to educate them on their condition(s) and needs. In order to create a true competitive market place in healthcare, consumers need to be given transparency and be armed with the right tools/resources to make a confident decision.