WSJ asks, “Can ACOs Improve Health Care While reducing Costs?”

Specifically the question that the WSJ posed in its article on January 23 to three health industry experts, (Don Berwick, former CMS Administrator, Jeff Goldsmith, President of Health Futures and Tom Scully, CMS Administrator from 2001-2004) was whether ACOs are the answer to what ails the health care system. As expected, the response from each of the three respondents differed in outlook, driven by their political, professional and personal perspective.

Don Berwick as the “architect” of a series of innovate healthcare delivery demonstration programs, including Medicare ACO’s, obviously is pro ACO – citing the goals inherent in ACO formation as improved quality of services, access and consumer choice, provided at a reasonable cost and accomplished by changing the relationship between provider, consumer and payer.

Mr Goldsmith questions the value of ACO’s, citing that ACO’s are self serving,  not provider friendly, expensive to implement, (an ACO implemented in a midsized market will cost about 30 million)  and most importantly don’t save patients any money while dictating to the patient the timing, type and quality of treatment available.

Mr. Scully takes a more middle of the road approach, indicating that he likes what Mr Berwick is trying to do but argues that  programs like ACO are not significant change agents with respect to timing and incentives. In his opinion ACO are just one minor part of a much larger solution, as yet undefined, that must be achieved to effect significant change in how the US provides healthcare. He does go on to offer a number of recommendations as to how to pay providers, believing as so many do that financial incentives are a more effective tool for changing provider and consumer behavior than any other.

My response is that their opinions about what is good and not so good about ACO’s and what is needed to get us out of the healthcare mess we are in is reflective of the debate as a whole.  Namely that there is no one size fits all solution to what ails healthcare as it is provided and priced.

ACO’s are not a panacea solution for what ails health care. It is not a model that can be replicated in all parts of the US via a rubber stamp process. The financial drivers underpinning the ACO enterprise is not a win/win proposition for everyone that makes a living from the healthcare industry.

Accountable Care Organizations are one tool out of an as yet ill defined tool box designed to help “fix” a healthcare system that is crashing around our ears. ACO’s offer a pathway for better coordination of services, better communication between provider and patients, a hopefully more realistic approach to patient diagnosis and treatment planning and ultimately a framework within which patients are more engaged in deciding what is best for them when it comes to healthcare,.

Oh and about that 30 million dollar pricetag for implementing an ACO.  Think about what an ACO is to do, i.e. organize care, offfer access to that care and provide better patient” thru put” in the inpatient and outpatient setting. Does that really cost 30 million to accomplish per enterprise?

We spend a lot of time, energy and resources talking about and reacting to the shortcomings of our approach to health services provision and pricing. Those critical of initiatives like the ACO enterprise argue that it is not new, hasn’t worked , is doomed to fail, etc.. What strikes me is that we spend a lot of time looking backwards to chart the future. Doing so makes it difficult to see what might be ahead when focused on what was and is.

I believe that every problem has a solution and sometimes those solutions are not grounded in the past but are new, innovative and to coin a phrase, (just kidding) must reflect out of the box thinking. Anyone up to the challenge?