If the last few months have made anything clear, it’s that the fiscal climate has changed and there are no longer any sacred cows. Medicare and other essential health programs are on the chopping block, despite their immense popularity and the fact that they stand between life and death for millions of the most vulnerable people in our country. As cuts to these health programs loom, the imperative to use our health dollars wisely becomes even more urgent.
If it’s time to discard the old ways of doing business, there’s no better place to start than with Accountable Care Organizations, or ACOs. At the very heart of the philosophy that underlies health reform, and with a history of support from both Republicans and Democrats, ACOs are a model of care that incentivizes medical groups and hospitals to reduce costs while providing high-quality care.
An ACO is a network of health providers – hospitals, primary care doctors, specialists, advanced practice nurses, physician’s assistants, home health care providers and others. Some are private; others are public. Under the terms of the Affordable Care Act, an ACO contracts to meet the health care needs of at least 5,000 Medicare beneficiaries for a minimum of three years.
ACOs Can Help Patients And Save Money Through Care Coordination …
A primary function of ACOs, and what makes cost savings possible, is that they coordinate care for their patients. This is tremendously important for the oldest and sickest patients who often have multiple health problems such as diabetes, high blood pressure, coronary artery disease, osteoporosis and early Alzheimer’s. In our current system, these patients struggle mightily to keep track of medications, test results and medical instructions. It’s no small task. Older adults with five or more chronic health conditions have an average of 37 doctor visits, 14 different doctors, and 50 separate prescriptions each year. That would be a challenge for a healthy person to coordinate, and it’s overwhelming for many of those who are sick.
These patients, who are the heaviest users of our health care system, also bear the greatest burden when our system offers poor quality care. They are at highest risk for medical errors, hospital-acquired infections, and care that makes them sicker instead of better.
Talking to these patients offers lessons in why quality, coordinated care is so important. One told us that trying to navigate the health system is like being in a foreign country with no passport, no ability to speak the language, and no translator. Their family caregivers say coordinating care for a sick spouse or parent is a full-time job. They say they create spreadsheets to try to keep medical appointments, medications and test results straight – often without success. They talk about a health care system that is failing the patients who depend on it the most.
Coordinating care isn’t just humane. It’s also smart. Because when care is coordinated, test results are shared with various doctors rather than tests being duplicated. Patients with early Alzheimer’s who go into the hospital for a heart attack don’t get sicker because they are given medications contraindicated for those with dementia. Patients with osteoporosis get fall prevention care so they don’t fracture a hip while being treated for diabetes. And when patients are discharged, they are less likely to be re-admitted because they went home without the help they needed to complete their recovery.
The poor quality care we are delivering also is costing us dearly. We’re wasting billions of health care dollars by making patients sicker. It’s unsustainable and, with deep cuts looming, we don’t have time for slow, incremental change.
…. But Only If We Maintain The Proposed Rule’s High Standards
If implemented right, ACOs can make a real difference by improving the quality and reducing the cost of care. With that in mind, this spring the Administration issued a draft rule to govern ACOs. It provides strong incentives to save money by avoiding unnecessary and duplicative tests, as long as the quality of care improves. The resulting savings would be split between the Medicare program and the ACO. But private purchasers of health care can reap the same benefits, when ACOs offer better and more efficient ways to deliver and pay for care for all patients.
As advocates for patients and payers, we saw a lot to praise in the proposed rule. We liked that it had high standards, focused on making care more patient-centered, provided payment incentives for care coordination, and used patient experience to assess and improve care.
Many in the provider community reacted very differently. They demanded greater upfront incentives to create ACOs, a greater share of the cost savings, and in some cases less accountability. And as providers challenged the proposed rule, opponents of health reform joined them in trashing it in ways that spiraled nearly out of control.
It’s time for a new dynamic. The disagreement between providers and patients is, at its core, a fight among family because in the end, we want the same thing: a health care system that works.
The world is changing. We seem to be entering a new era of permanent government austerity. Life-saving programs are on the chopping block, and Medicare and Medicaid are prime targets. The only way to avoid deep cuts in benefits or payments to providers is to adopt reforms that reduce cost and improve the quality of care. ACOs can do that, if we maintain essential features in the Administration’s proposed rule. Only then will ACOs offer real hope to improve the quality and coordination of care and use our health care dollars more wisely.
Patient advocates and providers must work together to get ACOs right, and opponents of reform must stop fanning the flames of disputes for political gain. Our nation is facing a health care crisis, exacerbated by the grim fiscal realities. If we want better health care at lower cost, we simply have to make fundamental changes in the way we do business. Let’s start by refusing to lower the bar on ACOs and instead come together to support a strong ACO rule and encourage the development of ACOs that will provide better care for patients.