• Pros and cons of accountable care: Is an ACO right for you?

    Author | Date June 12, 2013
    Physicians are hearing a lot about accountable care these days.  It will revolutionize the delivery and payment of services, ensure patient safety and care coordination, cut costs across the board, and save the practice of medicine from its imminent collapse.  Accountable care organizations (ACOs) and value-based payments are sweeping the nation, with 60% of health plans anticipating they will switch to pay-for-outcome medicine within the next five years, and small, independent ACOs cropping up across the country.
    While the promise of an interdependent, mutually responsible, comprehensive healthcare network sounds like a great thing to most people, providers interested in jumping on the bandwagon have to take costs and changes to the way they do business into account, too.
    Health IT and HIE can flourish
    Pro: ACOs promote health information exchange (HIE) that allows providers to communicate effectively and efficiently with other organizations, helping in the coordination of care for patients.  HIE is one of the major goals of Stage 2 and Stage 3 of meaningful use, so you’ll be getting a head start on some requirements you’ll have to think about anyway.
    Con: The IT infrastructure required for a robust accountable care network is expensive, and you’ll likely be investing in more than the minimum that you need right now for meaningful use.  Small practices with stretched budgets may want to consider whether the upfront outlay is worth the immediate return as they face ICD-10 and Stage 2 of meaningful use in the next year and a half or so.
    Group risk, group rewards
    Pro: You don’t have to pay for it all yourself.  Shared risk means shared responsibility, and building a network defrays the costs across all the members.  Joining with other providers means a wider net of data aggregation, better population health control, more options for your patients, and even greater financial security for solo practitioners who can lean on their fellow members for aid with new investments that will benefit the entire group.
    Con: Shared risk also means shared decision making.  A network of practices, each with its own individual priorities and visions, can cause some consternation when it comes to choosing a new direction or divvying up the bill.  If you value your independence as a practice, consider how joining an ACO will change your governance policies before signing up.
    Patient satisfaction and safety
    Pro: Patients receive more comprehensive care, feel taken care of, have access to more choices and greater benefits like care planning liaisons, and theoretically receive more tailored services, since providers will only be reimbursed for medically necessary tests and procedures.  Interdisciplinary care teams can increase the accuracy of diagnoses and support a patient with multiple conditions, even as the population of chronic disease sufferers and complex elderly cases continue to shoot upward.
    Con: With new health IT systems, increased information exchange, and more eyes on a patient’s chart, data security and patient privacy concerns become increasingly important.  Providers will need to coordinate with each other to ensure that HIPAA regulations are being strictly followed as data is shuttled back and forth to prevent improper use of sensitive information.  Providers will also need to ensure that patients don’t feel tossed back and forth between providers in the name of comprehensive care.
    Change is good…usually
    Pro: Payers want this.  Providers see it as the future of medicine.  The business case for ACOs is strong and only getting stronger.  Coordinated care is more than a nice phrase: it’s the way patients want healthcare to be.  With the proliferation of innovative care delivery models, home monitoring, preventative healthcare, and a greater emphasis on patient engagement and responsibility, the traditional family doctor is shifting from the arbiter of healthcare decisions to a “partner” in a seamless continuum of wellbeing.
    Con: You’re going to have to adapt.  Physicians aren’t always the most eager group to embrace change, and many older doctors are likely to choose retirement rather than change the way they practice medicine.  But just like the move from paper charts to an EHR, the growing pains subside as providers realize that better healthcare can result from new ideas.  ACOs are here to stay, and it’s up to you to decide whether you want to embrace them or not.
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