Are ACOs really a new concept?
A resounding No…and Yes.
The fundamental principles of an Accountable Care Organization (ACO) are simple:
- Care for patients using evidence-based clinical protocols.
- Consider the broader population’s health and well-being, not only the individual patient.
- Invest in preventative care in order to reduce healthcare costs in the long run.
- Remove the barriers that exist between the patient, the provider, and the insurer.
- Align incentives to ensure everyone is working towards the same goals.
None of these concepts are explicitly new. The concepts of investing in preventative care and managing long-term costs have been the prevue of public health departments for decades. And the U.S. saw efforts to remove barriers and align incentives back in the 1990s, with the emergence of many managed care organizations.
But it didn’t work then.
So what is different this time around? Technology.
Whether the legal ACO structure will remain is uncertain, but the principles that they are based on are quickly being integrated into the standard operating practice of healthcare organizations across the country. This is all being done through the adoption of new technology which, once in place with heavy up-front capital investment, is not likely to be removed based on political considerations.
This can be seen in a myriad of ways, such as:
- Widespread adoption of the Electronic Health Record (EHR) in order to meet Meaningful Use requirements.
- Development of clinical decision support tools, which parse through reams of information fast enough to actually be useful for decision making.
- Enhancement of the EHR with clinical alerts to potential problems.
- Presentation of information in context, including trending and statistical significance calculations that were impossible with paper charts.
- Support for patient-specific treatment options, based on a particular individual’s demographics, goals and desires, and biological characteristics.
- Bed-side education and semi-automatic documentation with mobile, wireless platforms.
With all of these positive developments that are technology-based, it is difficult to imagine that we will walk away from these changes, regardless of whether the ACO sticks around in its current structure.