Insights

Accountable Care Organizations. The new HMO?

If you haven’t already heard the term: Accountable Care Organization, get ready. It will be on the tips of everyone’s tongue in the next 18 months. Accountable Care Organizations are the new way that the “powers that be” are going to try curb our spiraling health care costs and improve our quality of care. As you may know, the US ranks poorly on most health metrics compared to other industrialized nations-and yet we spend at least twice as much per capita! The way they differ from HMOs is that they are more focused on health care delivery and less on the insurance/payment side.

For instance, employers and insurance companies may offer different ACOs to you to choose from. The ACO, which will include doctors offices and a hospital or hospitals affiliated with that ACO will accept payment up front to care for a certain number of people. If they do a good job (by keeping people out of the hospital for example), they will get a financial reward at the end of a certain period of time (that is being haggled over right now). Theoretically, a patient will be able to choose where to get their care but the ACO to which they belong will be motivated to encourage them to get their care within the ACO system (otherwise the ACO will lose money).

This shifts the burden of “managed care” away from the patients and onto the hospitals and doctor groups. Furthermore, the goal is to motivate the health care industry to really focus on customer service and patient satisfaction. Will it succeed? It’s hard to say. The Kaiser Permanente System is as close to an ACO as exists right now. Patients are generally happy with Kaiser, it continues to rank high in patient satisafaction scoring. However, we have had several Kaiser patients seek our services when they got diagnosed with serious disease and didn’t feel what they needed was “under the Kaiser roof”. In that case, Kaiser is obligated to refer out of network, and they do. ACOs will have to do the same. Perhaps it is not surprising then that  Kaiser’s costs and premiums continue to rise–which casts doubt on whether ACOs will really achieve savings in the long term.

Good Medicine Consult and Advocacy provides just the kind of services ACOs will develop: care coordination, patient education, medication management and advance care planning. The big difference is, we’re paid out of pocket by the patient. We are perceived by our clients as unbiased and on their side (true!). When money and cost savings are tied to it, I wonder if patients will feel the same way about ACOs? I hope consumers will have some influence over they types of services ACOs offer. It always amazes me that “patient centered care” is defined by government and health care systems and not the patients themselves (more on that in another blog post!) As a general principle, I think patients should have the option pay for counseling services out of pocket-at a reasonable cost…so that they know they are an individualized unbiased information that is only meant to help them get what’s best for them.

If you want to know about ACO’s, this is a good article.

If you want to see a cynical take on this latest trend in health care, see below:

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