The risk and opportunity of Accountable Care Organizations
June 30, 2010
You’re a patient getting care from a Group Health physician in a Group Health facility. All of the conditions are right for an evidence-based, medically appropriate, smooth and integrated experience. Our care model, our people, our technologies and incentives make it possible.
But here’s the reality: we don’t own all of the buildings where our members receive care. We also rely on thousands of contracted medical providers in dozens of non—Group Health facilities. Two-thirds of our clinical costs are incurred outside our own walls and in many cases care is provided by non—Group Health staff. And I believe in the future we’re going to have to look outside our own walls even more.
The flip-side of this risk is an opportunity that’s been decades in the making. Health care reform and pure market forces (like physicians leaving practice to join larger entities and hospitals hiring doctors right and left) have made conditions right for us to bring our way of practice to more people. Reform legislation has allowed Medicare to recalibrate some of its payment methods, and there are provisions in the reform act to support integration of delivery systems, along with financial incentives for better quality.
And with thousands of newly-insured people in our midst (500,000-600,000 in our state), we’ll have an obligation, and now a real opportunity, to partner beyond traditional contracted relationships and reach even deeper into communities with Group Health medicine.
In Executive Leadership Team meetings we’re having some creative conversations about how to move forward. We must honor our mission, our patients and our ways of practicing medicine. We’ll be watching as the federal government defines the rules for operating as an Accountable Care Organization (ACO). While we have always been an ACO by almost any definition, by enhancing our integration with other community providers we have the potential to spread our influence and practice culture to many more patients.
Yes, we’re growing enrollment—over 80,000 new members in the past three years—but we’re still just 10 percent of the region’s health care market. We have to maintain growth and thrive in a changing landscape where unlikely partnerships are emerging overnight. The hope of accountable care is that collectively—fueled by structural changes (such as paying for value instead of volume and sharing IT systems and quality goals and programs) and cultural conditions (like shared values and patient-centered approach)—providers can better manage cost and quality for a population and create a sustainable business model.
Shared values, physician-led care models, and aligned incentives can bridge the distance between organizations in the world of accountable care. Some experts say that complete implementation of health care reform will take 10 years—half a generation. Now is the time for us to emerge, participate and lead. Very few organizations even have a realistic chance to make this work in today’s world.
President and Chief Medical Executive
Read Dr. Soman's latest Open Mike article.
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