By Holly Hayes
A Wall Street Journal article from last week, titled “The Future of U.S. Health Care”, asks in the subtitle: “What is a Hospital? An Insurer? Even a Doctor? All the Lines in the Industry are Starting to Blur”. The same questions apply to the development of the Accountable Care Organization (ACO).
Marc Bard and Mike Nugent provide some comprehensive answers about ACOs in their book: “Accountable Care Organizations, Your Guide to Strategy, Design, and Implementation”.
Although only four pages of the Patient Protection and Affordable Care Act of 2010 (PPACA) address the development and deployment of the ACO, no other aspect of the PPACA, with the exception of Medicare rate regulation has received as much attention as the ACO. Bard and Nugent describe four perspectives in the health care industry on the intent of ACOs:
- Those passionate about clinical quality improvement see the ACO as a means to achieve their goals.
- Those driven by the need for greater efficiency and cost management see the ACO as a potential pathway to that end.
- Those seeking improvements in population management see the ACO as a potential step in the right direction.
- Those focused on physician development and alignment see the ACO as an opportunity to achieve those goals.
The successful implementation of an ACO must integrate all four perspectives. The authors state, “In brief, the ACO is not really an entity as much as it is a contractual relationship that consists of delivery and financing tactics between an organized healthcare delivery system and CMS or another payer to provide measurably high quality care efficiently and to share the benefits of efficient delivery with CMS (and possibly with patients)”.
How those “contractural relationships” are developed will predict the success of the ACO model. We welcome your thoughts on building healthy relationships as part of a successful ACO.
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Holly Hayes is a mediator at Karl Bayer, Dispute Resolution Expert where she focuses on mediation of health care disputes. Holly holds a B.A. from Southern Methodist University and a Masters in Health Administration from Duke University. She can be reached at holly@karlbayer.com.
