At the 2011 University of Miami Global Business Forum, a panel was convened to discuss accountable care organizations (ACOs).  This panel broke new ground in answering how health care reform and market forces will create patient-centered care and ACOs.   ACO is defined by the Centers for Medicare and Medicaid Services (CMS), as “an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it.”
Some of the nation’s top thought leaders participated on the panel:
Delos M. Cosgrove, M.D., President and CEO, Cleveland Clinic Foundation; presented the foundation model for patient-centered care.
Steven K. Jones, President and CEO, Robert Wood Johnson University Hospital; presented accountable care from the academic medical center perspective
John Bigalke, Vice Chairman and U.S. National Industry Leader, Health Sciences & Government, Deloitte LLP;presented accountable care from the academic medical center perspective:
Anthony Rodgers, Deputy Administrator, Center for Strategic Planning, CMS, U.S. Department of Health and Human Services; presented accountable care from the government perspective.
John Kirsner, Health Care Partner, Squire Sanders & Dempsey; moderator.
Participants agreed that unlike the 1990s, we have uniform consensus that the healthcare system is broken and all stakeholder groups will be better off if they work together to find viable solutions.   Several trends emerged through the presentations, providing a window for what patient-centered care, benefiting from this new found cooperation, will look like at hospitals in the future.
1)   Dramatic change is coming in how hospitals, physicians, and insurers will be incentivized.  The focus will be on quality, not quantity.  Some hospitals have already begun providing salaries for surgeons and physicians so that they receive the same pay regardless of how many patients they see.  The government and insurers will begin increasing allocations for services to ACOs who have fewer patients returning to hospitals prematurely.
2)   Electronic medical records mean better outcomes for patients.  The government is incentivizing the transfer to electronic medical records, providing hospitals and providers with funding and support to create a streamlined, consistent system.  Electronic medical records will create the ability for providers to monitor trends in patient care.  And the instant access of this medical information at different locations means that providers will be able to see immediately a patient’s treatment history for other reasons that may be related to the current visit.
3)   Better preventive health measures need to start before the patient gets to the hospital. Obesity and smoking are the largest causes of premature mortality and a leading factor in driving health care costs.  The Cleveland Clinic Foundation has caused dramatic change in the community by refusing to hire workers who smoke.  This change has resulted in a dramatic reduction in the number of smokers in Cuyahoga County, where the Clinic is located (a drop of over 10 percent, putting the county below the state and national averages for percent of people who smoke).  And the Cleveland Clinic now offers its employees wellness benefits like diet foods, yoga, and fitness centers, which has resulted in 188,000 pounds lost.  Leading by example transfers to the community.  Employers need to be encouraged to develop similar programs.
4)   Episode-based bundled payments will result in better team care for less cost.   ACOs will increasingly be able to address a problem, for example a patient with a knee replacement, from diagnosis, through surgery, recovery, rehabilitation, and prevention of further injury.  And when the ACO is awarded one payment from CMS or insurance that may increase in value if the ACO shows improved metrics, the patient will get better faster and costs will drop.  In the future, we’ll look back at our current system as if we were building a car from scratch, buying new parts separately.
5)  Newer strategies for physician-hospital “alignment” will benefit all.  First attempts during the 1990s to align physicians and hospitals failed because these were seen as purely economic plays without focusing on patient-centric outcomes.  New calls for alignment are driven by reductions in fees from Medicare combined with a poor economy – universally accepted realities.  Combine that with awareness that hospitals will become major aggregators and distributors of payments for services, and the increased desire of physicians to have control over their work/life balance, resulting in increased willingness to align.
6) Concerns over violations of antitrust laws are on the rise.  Discussions among providers considering the formation of an ACO can raise concerns under antitrust laws, particularly when those providers are otherwise considered competitors in the market. Providers engaged in such discussions should seek counsel to ensure that their activities comply with antitrust laws.