The new buzz phrase in my world is "ACO strategy." People want to know what it is and who is starting one. Let me back up to about a year ago, when I asked, "What the heck is an ACO strategy?" Sometime the acronyms we use in healthcare can be very mystifying.
ACO stands for "accountable care organization," which is one piece of what the Obama administration has initiated as part of the Affordable Healthcare Act. The goal of an ACO is to ensure seamless, patient-focused care by a group of providers (hospitals, physicians, pharmacies, and others) working together in all care decisions. There are incentives for the healthcare providers within an ACO to assist an individual patient across all care settings.
Here is an idea that has been a long time coming. Imagine having shared information that goes with the patient from hospital to home care to pharmacy. I believe the stumbling block will be developing the technology to collect this information across all care settings while staying within all HIPPA and other regulations. I see a growth spurt in the healthcare IT industry as developers compete for ACO business. The technology to support this initiative is referred to as health information exchange.
Initially, ACOs will be formed to treat only Medicare patients, not patients on Medicare Advantage Plans. Based on the demographic data reports, two out of three Americans over 65 have multiple chronic conditions, and they account for 93 percent of the Medicare fee-for-service expenditures. Another startling fact costing our healthcare system is that one out of five Medicare patients are readmitted to the hospital within 30 days of discharge.
Think of the patient with multiple doctors, and then think of the multiple opportunities for duplication or overuse of services, along with the risk of medical errors. I think of the oncology patient with one or more comorbid conditions.
- How well are other providers kept in the loop during oncology treatment?
- Looking at it the other way around, how proactive are we in getting information when a patient visits a general practitioner and is treated for another condition?
Imagine a shared, real-time EMR (electronic medical record) input process for all providers, including the pharmacist. This would take much of the burden off the patient.
There will be a Medicare shared savings program, or incentive, for ACOs that lower the growth in healthcare costs while meeting the performance standards, which have a emphasis on quality and putting the patient first.
Who are forming ACOs?
Primarily, physicians are banding together with one or more hospitals. There are health plans working on their strategy now. As Information Week Healthcare has reported, the Centers for Medicare and Medicaid Services have just started contracting with 89 ACOs that cover nearly 1.2 million Medicare beneficiaries in 40 states and Washington, DC. If you include the organizations that had already contracted with the centers, that's a total of 154 ACOs taking care of about 2.4 million patients.
Is your hospital, physician group, or other healthcare provider working on an ACO strategy? How do you see this working to improve patient care? Dose this approach sound a little familiar -- and do the letters "HMO" come to mind? Hopefully, we have learned from our HMO days and have come up with a strategy that may change healthcare delivery while focusing on the patient.
You can learn more about ACO models in an Avascent Group whitepaper (PDF).