In 2010, the Affordable Care Act launched a coverage reform while also establishing the need – and setting the standard- for coordinated care. No longer was it acceptable for patients to “fall through the cracks” – and with the advent of the electronic medical record, there were far less legitimate excuses as to why a patient’s needs were overlooked. With this too arrived the concept of The Triple Aim, which has created an equal playing field not only for patients, but providers and payers. It’s no longer enough to provide good care, you must do so as efficiently as possible while also spending as little money as possible: no small task.
Another way that our current healthcare reformation differs from the last is that we are now more than ever aware of the need for a population health focus rather than the individual. While it is often said that “healthy people don’t make money” for healthcare, that is precisely the kind of improperly focused thinking that has caused costs to skyrocket in the last decade alone. ACOs will shift the focus to a broader picture of healthcare. Our population’s health is reflective of our healthcare system’s health. MCOs, on the other hand, were not aware of or ill-equipped to tackle the “bigger problems” in healthcare, and therefore stuck to relatively small potatoes. With our annual healthcare spending continuing to spiral out of control- while our quality of care and access to care has not similarly spiraled upward – it’s clear that the focus needs to encapsulate much more. Through coordination of care, which EHR’s will no doubt continue to support, ACOs will allow patients to have a care team that works in tandem to support them regardless of where they go to receive treatment. It is no longer acceptable for physicians to work in silos, nor is it any longer the norm for physicians alone to be the “keeper of solutions” – with the internet, now more than ever patients have access to information that can, if accurate, inform them and provide confidence for advocating for their needs. The healthcare system would be wise to embrace that, since ACO’s payment standards will be largely focused on patient reported measures, like satisfaction with care.
Managed Care does have some similarities to Accountable Care, but the differences are very important to consider; in many ways, Accountable Care is a more evolved and informed form of Managed Care which has had the privilege of several decades to observe what the major conflicts and challenges in healthcare reform are. As we continue to move away from fee-for-service and embrace models of payment that are not going to be wasteful and easy to abuse, we will hopefully also see less and less substantiated arguments that claim ACOs are largely ineffective. While it is too early for anyone to know for sure the impact of ACOs, preliminary data would suggest that we are off to a respectable start.
