Accountable Care Organizations are further along in their understanding of the model, of course, but when I talk to other healthcare providers, there is still a lot of confusion over ACOs and what the model means to them. Providers must appreciate that there are both clinical and business issues to be managed, and there is no question that the train has left the station. In fact, Forbes reported in November that Accountable Care already touches 1 in 10 patients.
The question asked in the title of this post is, "Does Accountable Care Create Sustainable Innovation?" The answer is an unequivocal yes, it does. Here are some of the issues and the rationale why this is rapidly becoming true already.
Unfortunately, the current system, or more accurately, the one we're moving away from, actually served to depress innovation. Mediocre providers with poor outcomes were paid the same as the better providers with spectacular outcomes. In what other business would you ever accept that? Simply put, there were no rewards for doing things more efficiently or at lower cost, or collaborating with partners better. Or keeping patients out of hospitals. Or helping them to manage chronic conditions better so they would not have to visit the hospital as often. All that has changed, and providers need to raise their awareness of Accountable Care and how they fit in the model. Whether you expect to be an ACO or not, your business will be greatly impacted by ACOs. A significant share of your revenues will be directly driven by ACO involvement. Those providers that drive value to the system, that contribute innovation to the system, will become the most desireable providers to work with and be best positioned to benefit from it.
Hospitals that Ankota works with are well versed on the concepts and objectives of Accountable Care, even if they themselves are not an ACO. Many of the post acute providers we work with, however, are confused over what exactly the opportunity is for them. Some even perceive ACOs as a threat to their business, but do so in error. There are likely many reasons for the discrepency in perceptions, not the least of which is the more formalized nature of communications in hospital & research environments, the more active lobbies of hospitals (relative to other types of providers, etc), "largeness," lack of business/administrative resources among smaller providers, and so on. In short, hospitals are seemingly organized together, while their counterparts in post acute care remain fragmented across many segments.
Because of this, the "voices" of post acute providers are also highly fragmented, which is a reflection of the historically fragmented business & payment models. For example, an HME organization thinks it is in the business of delivering medical equipment and is paid separately for such, regardless of patient outcomes or contribution to the model. A physical therapy agency may tell you that they provide physical therapy or rehabilitation in the home, and a home health agency might say that they provide nursing services in the home or community. This is even reflected in the associations that are specific to each of these segments of post acute care. Even the associations do not cooperate. These may have been just descriptions under old healthcare delivery models, but in the new era of Accountable Care and intense focus on managing Care Transitions, these are highly secular views that lead to gross inefficiencies and in many instances, poor quality of care. It so stifles innovation by limiting those who can contribute to innovative thinking and delivery of services. This fragmentation adds complexity to an already challenging model, yet provides huge opportunities to better coordinate services using innovative technology. Not surprisingly, that's where Ankota makes its market.
The fact is that each of these providers plays an important role in assuring the success of the patients they serve, and therefore play an important role in assuring the success of the providers with which they interact, which makes up the Accountable Care model, at large. Providers share dependencies among them, which until now have gone largely unmanaged. Managing Care Transitions is a critical element of Accountable Care, and an area ripe for tremendous technologoical innovation. Click the blue button to learn more about how Ankota technology helps to manage Accountable Care and Care Transitions.
That's right, innovation requires collaboration.
If a patient needs to be administered an antibiotic in the home after being discharged from the hospital, there are often multiple providers that have to collaborate to deliver a single, integrated service. The discharging service or primary care physician must develop and communicate a comprehensive care plan. The plan must identify needed providers based on skills and certifications, geographic considerations, availability and quality measures like propensity to be on time and perform quality work. The timing and delivery of services must also consider dependencies such as "the antibiotics must be delivered before the infusion nurse gets there." The bed, IV pole, and infusion pump must be delivered prior to the infususion nurse's arrival, and constraints like timing of services and availability of the patient must be managed with other requirements. It is not uncommon at all to have 3, 4 or even 5 providers providing services in the home for an elderly patient or for a patient who was recently discharged from the hospital.
With so many providers engaged in delivering services for patients, innovation simply cannot be left to one organization to decide for the rest. Innovation in a vacuum simply does not work. This is one of the reasons why, though it is seldomly discussed, the creation of Accountable Care Organizations will actually fuel innovation. Through payment reform and accountability, it funds the creation of ecosystems of providers where the dependencies among providers becomes obvious to all. The shared rewards system provides incentives for those who improve the process and the cost of delivering care, as well as the outcomes.
Now that the dependencies, the incentives, and the consequences have been aligned, all providers are provided a voice and a forum in which to express it. Providers now have the opportunity to contribute to innovation with this seat at the table. When all providers in the ecosystem share both the risks and the rewards, incentives are aligned that assure commitment, responsibilty, and dramatically greater innovation.
Payment models have aleady shifted and will continue to shift, and providers are already being forced to manage dependencies among them. Accountable Care models create new dependencies and exacerbate old ones, which assures that the professional focus of managing Care Transitions will only accelerate. It is here where services must be coordinated among numerous providers, care plans, results and performance are shared. New technologies are required to manage the model.
Fundamentally, Accountable care organizations (ACOs) are a method of integrating local or regional healthcare providers with other members of the health care system and rewarding them for controlling costs and improving quality. In one sense, this sounds like other efforts we've heard about in the past like Health Maintenance Organizations (HMOs) and Physician-Hospital Organiztions (PHOs). However, with alignment in the payment system both public and private, and shared risks, the ACO model promises to be one that more closely resembles a market driven model and rewards innovation. And with 10% of patienst already being cared for under the model, it is rapidly gaining momentum and is here to stay.
Leaarn more about ACOs from Healthcare.gov and in this CMS video