Do Accountable Care Organizations Work?

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As the federal government takes a closer look at accountable care organizations, many wonder if the promise of getting doctors, hospitals and other health care providers on the same page will ever bear out. Namely, will it improve care and lower cost?

“An accountable care organization is a very appealing idea,” said Alice Rivlin, director of the Health Policy Center and Leonard D. Schaeffer Chair in Health Policy at Brookings Institution, a panelist who spoke about ACOs at a breakout session Tuesday morning at the 2015 U.S. News Hospital of Tomorrow Conference. She joined fellow panelist Kenya Woodruff, a partner at international corporate law firm Haynes and Boone, LLP, who has been working with providers on creating partnerships to further the ACO model, in a discussion moderated by health care reporter Kimberly Leonard of U.S. News & World Report.

To date, experts say ACOs haven’t lived up to the hype. “So far the results have been very disappointing,” Rivlin said. While the drive to build ACOs to better coordinate care has arguably led some organizations to meet quality metrics, much debate remains about the extent to which that translates to meaningful improvements in care for patients, and, Rivlin said, ACOs haven’t dented cost.

That’s not to say it’s solely the fault of a flawed model. Factors ranging from an aging population to patient demand for the latest, greatest drugs and treatment all mean “upward cost pressure,” as the price tag for health care in the U.S. continues to grow. That comes at a time when the federal government, through incentives to providers – such as in ACOs – is trying to cap that cost.

Experts also talk about the importance of getting buy-in from patients to make ACOs work. Rivlin noted many patients don’t know they’re getting care through an ACO; she suggested setting up a system whereby patients enroll in accountable care organizations and similar models. She added that such models need also to appeal to the motives of physicians to provide the best possible care to their patients.

“We should  increase the incentives, but it isn’t all just about money,” Rivlin said, calling for improvements to how the quality of care is measured.

Woodruff said continuing to innovate in getting providers and payers to come together remains central to improve ACOs and the delivery of care. Such efforts must account for marketplace realities, ranging from hospitals seeing an impact on their bottom line by successfully lowering hospitalization rates through better coordinated care outside hospitals to push back from independent physicians. Some doctors wonder, Woodruff said, “Will this dictate how I practice?” On the flip side, she and others working on ACO arrangements must also gauge the dangers associated with aligning many different health care organizations, from whether it meets legal muster to if it limits patient choice.

Rivlin added that more needs to be done to seamlessly move digital patient information between providers. Still, despite all the challenges, experts say there’s opportunity, too, for health care providers to work together to lower cost and improve care. 

“There’s a lot of room to be inventive about the relationships,” Woodruff said.

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