ACO - Why it matters to you.

#in Accountable Care Organizations (ACOs) will likely impact all of us in the near future - either as patients, healthcare employees, or tax payers.

Currently, healthcare spending is increasing at an unsustainable rate of about 5%, projected to increase to as much as 8% potentially. This represents almost 20% of our national GDP, with 45% of costs covered by government (read taxes). If a really big number makes sense to you, we spend almost 3 trillion dollars per year on healthcare.

What do we get for our dollars? Currently, we pay for what we get. Get an MRI done, pay. See you doctor in the office, pay. Here's the twisted piece for our system of healthcare: it makes money currently only for ordering tests, taking xrays, seeing patients for office visits. If we keep patients out of the Emergency Department, keep them off medications, keep them from needing to come in for appointments - no collection of fees, no paychecks, no hospital. There is no malice on the part of individuals (healthcare is still full of altruism) - it is the system that is misdirected. Preventing disease-related expenses simply doesn't pay.

ACOs are one attempt at flipping that system. If I, as a doctor and as a piece in a healthcare organization, can keep my patients healthy - prevent problems and limit impact of chronic disease - the insurance companies save money. And someday the savings will get shared with my employer (the ACO), and I can still collect a paycheck. Better care, lower cost, shared savings. Value. Since you (tax payer) are spending money on 45% of the cost of healthcare, lower expenses matter to you. Since you (patient) will still get excellent care (likely even improved care based on some studies), you also win.

What's the link to healthcare information technology? ACOs will be required to produce proof that they provide value (quality care and cost-savings). To demonstrate quality, ACOs will furnish 33 reports annually to the government. These include measures for patient satisfaction and access to care, good preventative services (eg colon cancer screening), and management of chronic diseases associated with high costs (eg diabetes). Not only does it take a team of computer programmers to write the software code for the reports, but it will take a team of clinical informaticists (doctors and nurses who work with tech services to improve care delivery) to design the medical records and clinical protocols to gather the right data and drive improved care.

In many situations, giving people feedback on their work will drive improved performance. There is some evidence that telling physicians how often they do (or don't) provide the recommended care will lead to improvements. In addition, electronic charting tools can include automated reminder systems to alert both the physician and the patient (via letter or secure, online patient portal) that they need specific follow up care (eg overdue mammogram). Building these systems requires a large commitment of human resources and capital investment by the ACO (hospital, etc).

Initial experiments of ACOs across the country are providing optimism that this intense level of technical support, reporting, and shared savings can bend the cost curve and cut the growth rate of healthcare spending to below our economic growth rate. Oh yeah - and it can improve patient care, too!

Stay tuned for ACOs near you - they are likely just beyond the threshold.