Five Things Docs Should Look for in an ACO, Including a Mirror

Pondering joining an ACO?

The Disease Management Care Blog was quoted in Software Advice's article on how primary care practices should join accountable care organizations. While regular readers won't be surprised by the DMCB's underlying skepticism about ACOs, this article does a nice job of introducing the topic of "risk transfer."

As the DMCB understands it, risk transfer is a contractual agreement to exchange money for risk.  In the instance of ACOs, provider organizations are agreeing to accept risk in exchange for a piece of any savings that accrue from managing that risk. If it sounds like doctors are adopting many of the features of insurance companies, you're right. Whether they also adopt many of the bad behaviors of insurance companies remains to be seen.

What the ACO wasn't aware of was data suggesting that the price of admission to the money-for-risk game can range between $11 and $26 million. In order to get a return on that kind of investment, physicians are going to have to figure out how to manage down a lot of admissions, specialty referrals and procedures.

At any rate, according to Profitable Practice, five elements that a primary care practice should look for in gauging an ACO partnership are:

1) Teaming: the presence of (nurse) care teams armed with protocols, plus strong internal quality improvement systems.

2) Physician-led: visible and smart physician leadership who understands health reform

3) EHR: A functioning and organization-wide EHR

4) Patience: Practice change will take more than a year. Learning collaboratives can help.

5) A Mirror: docs need to ask themselves if there is a willingness commit special attention and time to high cost, chronic conditions that generate hospitalizations, repeat visits and costly procedures. Non-physician providers will be able to do the routine care, while it will be the physicians who will need to spend day after day with complex patients.

The U.S. Health Care Debate in Five Bullet Points

"This message will self-destruct...."

The international arm of the Disease Management Care Blog is working on a presentation for the upcoming Hauptstadtkongreß in Berlin Germany.  Its "Mission Impossible" is to explain the U.S. health care system to a group of German hospital executives in a half hour.

This, in a Nußschale, is what the DMCB intends to say, using approximately eighteen PowerPoint slides:

1. While rising health care costs, as a percentage of U.S. GDP, has always been a problem, rising health care costs as a percentage of U.S. debt is widely viewed as a highly significant threat. We mean it this time.

2. The conservative vs. liberal debate over how to reduce health care costs for the U.S. government is ultimately about transferring its insurance risk.  The conservatives want to transfer risk to patients in the form of vouchers, while the liberals want to transfer risk to providers in the form of bundled payments and gain-sharing.  The liberals, so far, are handily winning the debate.

3. Risk is only half the health reform story.  The other half is quality. There is bipartisan consensus that a) U.S. health care quality could be better, and b) greater quality will mitigate insurance risk, resulting in fewer medical complications, emergency room visits and readmissions.
   
4. There is additional bipartisan consensus that a) insurance risk can be managed and b) quality can be increased when care is provided in large vertically integrated and regional provider systems.

5. If the twin exigencies of risk and quality are not addressed in the next 3-5 years, disappointment could lead to the unraveling of Obamacare and the introduction of a public payer option.

Image from Wikipedia