By Gregg A. Masters, MPH
One of the few ACO gatherings I’ve missed since the birth of the industry (and there have been quite a few since there are ‘experts’ everywhere), but the line-up NEHI put together is well worth a look.
Both Steven Shortell and Molly Coye are definitely change agents on the front lines as is the balance of the faculty. Molly is pulling levers of a major institution with, some might say, an impossible reinvention agenda given its governance complexity and cost efficiency obstacles – unlike many other private institutions similarly challenged, while Shortell has a pulse on the healthcare ecosystem DNA, the macro policy dynamics of managed competition, and the empirics of business or service delivery models that work.
Thanks to the organizational initiative of NEHI staff. A bit of a delay (this is raw footage), but fast forward to 9:10 mark for introductory remarks by NEHI President Wendy Everett, ScD. About NEHI:
‘…NEHI is a nonprofit, health policy institute focused on enabling innovation that will improve health care quality and lower health care costs. Working in partnership with members from across the health care system, NEHI brings an objective, collaborative and fresh voice to health policy. We combine the collective vision of our diverse membership and our independent, evidence-based research to move ideas into action.’
As discussed elsewhere the battle at the moment is for the narrative on ACOs and by proxy the Affordable Care Act aka “Obamacare”. For context see: The ACO Narrative: ‘Accountable Care 2.0 is a Journey, Not a Program’ or ‘ObamaCare is Toast’?
Key take-aways from the summit included:
- ACOs necessitate thinking about “packaged” innovations – the organizational culture, process improvements, and payment models that surround a particular innovation.
- Bundled payments, global budgets and other new ACO payment innovations are beginning to create the “markets for health” that will move the system from a culture of care to a culture of wellness.
- In an ACO world, physicians require comparative effectiveness research, real world evidence, and ongoing guidance from industry to achieve improved patient outcomes.
- ACOs are transforming the research landscape by turning previously unintegrated health systems into research organizations.
- ACOs have created new opportunities for cross-sector partnerships to share data and enhance the pace of innovation.
acowatch.me 
Very informative. Thanks for posting this. We recently ran this piece on how individual Pioneer ACOs fared in their first year: http://bit.ly/16ePM02. Feel free to share your thoughts on it.
I keep reading a lot of lofty ideas on ACO’s without any proof. It reminds me of the lofty ideas of HMO’s and we all know what happened with HMO’s. In my mind the patient should be our top priority.
No one seems to discuss the incentives even though the incentives of ACO’s are very similar to the incentives of HMO’s. We should see the same problems with ACO’s that we saw with HMO’s.
As noted in prior studies and the major study by Ware, the poor, elderly and sick got worse care in Medicare HMO’s than they did in fee for service HMO’s. These lofty ideas are meaningless unless the incentives are changed from those seen in HMO’s, but they can’t be changed because an ACO is nothing but a bigger and stronger HMO.
Hi EMil:
Sorry for delay in posting your comment. Thank you for sharing.
As far as the points you raise. One observation I’ll make is healthcare is complex and very hard to generalize. There are always exceptions and local variations to otherwise national assumptions.
When the HMO Act was passed they were organized as local, community based non-profit entities responsive to their members and community. That changed in the late 80s and took on big momentum with corporate acquisition of sometimes struggling HMOs seeking needed capital to upgrade and remain competitive in their markets. As a result a Wall Street fueled acquisition bonanza played out over the better part of the decade. HMOs went from primarily service oriented health plans to for profit operators.
In terms of ACOS, they are much less prospective by law and regulation, so once you’ve seen one, you seen – well – one. This is a good news/bad news story. The good news is flexibility and the potential for innovation. While the bad news is lack of standards or coherence as to what is in fact appropriately called an ‘ACO’. This has resulted in lots of confusion and much liberty taken when ascribing the the label to a enterprise that has taken on the goals of the triple aim.
We shall see. Thanks!
Gregg
Thanks Greg. Health care is indeed complex. We don’t really know how things will play out because all the rules aren’t well understood. The only thing we do know fairly well based upon experience is that incentives are very strong and somewhat predictable. That is what my query is all about. How are the incentives of ACO’s significantly different than HMO’s whether the earlier ones or the later ones? The only thing I see is that ACO’s might very well be even more powerful and thus the bad incentives might be magnified.
If the ACO’s do the same as HMO’s then the debacle will be repeated and health care costs will even be harder to control. That is why beforehand we should honestly look at them, both the good and bad, so that we can enhance the former and protect ourselves from the latter.
Can you tell me how the incentives have changed?
Emil,
Changing is perhaps a more accurate characterization. Need to get longitudinal here for context. Think capitation circa 80s/90s followed by crashing and burning of immature, ill prepared ‘me too’ forays into clinical risk assumption and little if any infrastructure let alone culture to manage. Then HMO trashing as in ‘ as good as it gets’ flick sealed the risk push-back era followed by a ‘return to our core business’ revenue maximization game played by fee for services hospital systems and their brethren medical staffs, medical groups and pet cash cow service lines (cardiac, ortho, you name it).
Now that healthcare isn’t just a corporate board room chat, but threatening both national and global economies, we’re hearing about value vs. volume, bundled pricing and yes capitation again.
So we’re bitting the apple one more time, perhaps with more measured risk aided by several of the CMMI programs (value, bundled pricing, transitions of care, etc).
A moving target, in my view.
Nice post you have, the Accountable Care Organization Summit is the leading forum on accountable care organizations (ACOs) and related delivery Systems and payment reform. They are delighted to announce the latest offering in their healthcare line up of events. Thanks for sharing.