ACOs Won’t Work? What Really Matters When Discussing the Next Steps in Health Reform

It is interesting that most conversations about healthcare reform either start out or turn very quickly to a discussion of the financial ramifications/barriers/challenges—place whatever moniker you will on it but the conversational road leads most often to the topic of how to best finance healthcare or how much to cut the cost of healthcare. 

 Lost in all the discussion is the fundamental truth that we pay more, achieve less results, and increasingly experience limited access, ( for many different reasons that I will explore another time) than most of the industrialized nations we compete with on the economic world stage.

We are quick to point out our advances in medical technology, pharmaceutical options and treatment breakthroughs but happily ignore that many people forgo regular checkups or skip medications because they can’t afford the cost. We disparage government funded healthcare in other nations as socialistic but ignore that the citizens of those nations have a quality of life as measured in longevity and overall health that is better than our own in many areas.

And consistent with our historical approach to healthcare, we immediately attack the  concept of providing the right healthcare at the right time in the right setting for the right cost as unrealistic, as impossible to implement, as something that would negatively impact the current revenue stream generated to the healthcare stakeholders that rely on the current system for collective and individual gain.  In a recent blog post, Bob Laszewski noted that ACOs will “only work if the provider gets paid less for the same patient population … Only in the policy wonk netherland does that compute.” 

Accountable Care Organizations, appropriately implemented, have the potential to positively impact certain aspects of how healthcare is currently delivered.  Fundamentally an ACO enterprise is all about providing coordinated, cost effective care in the most appropriate setting: call it Accountable Care, name it an integrated service delivery approach, refer to it as patient-centered medical care, or whatever moniker one wishes to ascribe. What is important is the recognition that the approach to the delivery of healthcare, the pricing of that care and the expected outcomes of that care requires fundamental change. It requires us to rethink our values and expectations and reengineer the current clinical, financial and education systems.

Is that a complex undertaking many years in the making? Absolutely! Is it a responsibility that we as a nation can afford to ignore? Only at our peril. Think of it this way: Every day  approximately 3,500 people age into the Medicare system. Following behind are several generations of individuals whose use/utilization of the healthcare system has already been charted by virtue of life style and abandon with respect to individual responsibility for wellness.

Who is going to shoulder the burden of providing proper healthcare to these individuals? And who is going to pay the price?And what type of healthcare can we expect five, ten, fifteen, twenty, or twenty five years from now?

There is no ready answer and no magic solution. However, I am reminded of an old commercial regarding the advisability of ongoing maintenance vs. crisis maintenance. The message? — you can pay me a certain amount now or you can pay me a whole lot more later. Seems to apply to healthcare … don’t you think?

ACO’s are not the panacea for solving what is wrong with healthcare. The ACO nomenclature may disappear soon or the concept may be modified beyond recognition. That is not really the point. The point is that we recognize that the current approach is unsustainable and that the moment calls for creativity, experimentation and faith.  We have no option but to find a new approach to the delivery and financing of access to healthcare services. ACO’s can be a tool in that effort to creating a workable solution. Every problem has a solution. We just need to look in the right place, apply common sense and set aside our own vested interests. We might surprise ourselves with the results.

Now if we could just……….