Surprise Surprise: ACOs are Touching More Patients than Expected (INFOGRAPH)

There’s no silver bullet. What you’re trying to accomplish in any ACO is a significantly higher level of patient engagement, accountability, and responsibility. You want to be patient-centered in your thinking, and you want to be working harder to keep [patients] themselves healthier through the different choices they’re making. And of course, there are significant changes to care delivery as well. You need to get the doctors to work differently with each other and other clinicians. There’s also the big shift from a more of a reactive care of the sick to a proactive mentality. It’s a big switch; you can’t really flip a switch. The whole clinical transformation; there’s no way to short circuit that, it’s time intensive, it takes a lot of effort. And then in order to make those models work, you need a different data infrastructure and a different analytics platform. All of these things take a lot of time. And you can’t go forward on any of this unless you have a committed leadership team and you have enough trust built up among participants to take what will feel like a leap of faith.

The report mentions the role payers play in successful ACO. How is this changing atmosphere bringing these two sides together?

In the prevailing environment, payers and providers lock horns because they are win-lose negotiations with each other and they are literally fighting over the same dollar. In the value-based world, the integrated supply chain that’s inclusive of the payers, providers, and everyone else is all tuned towards higher quality and lower costs. Everyone has the same goal and the incentive structure gets aligned so that as more valued is created, there is more value that is accrued to each of the participants. Sure, they’ll fight about how much value should accrue to one versus another. But that’s a different locking of horns, that’s how we split up the pie of value we’ve created for another versus how do I take more money away from you and give it to me. The nature of that relationship is very different.

For payers, they do have an important role to play in this. And to the extent they are able to provide the types of things the aspiring ACO needs, whether that’s data, infrastructure, or capital, as long as they have the right value-based contracting relationship with them, that’s going to be beneficial.

At what point will critics of ACOs acknowledge their effectiveness? How can they be won over?

I think you’re going to see the criticism persist for a long time. Some critics don’t like change, they don’t like the direction this is going. It’s threatening to a lot of different interests and they see some of that. The other piece is that you have a movement that’s very nascent and hasn’t had a big impact on cost and quality at the national level. Until that happens, critics are going to keep saying, ‘see it’s not working.’ Because of the magnitude of the change agenda, it’s appropriate to look for more leading indicators and think about whether it’s working or not, rather than look at the overall score.