Commentary: The Inevitable Changes Requiring Accountable Care

Date: 05.15.2013 | Zach Urbina">Zach Urbina

Affordable Care Act, health IT, accountable careBy now, you’ve probably read it and discussed it with colleagues. The frustratingly simplistic assessment of Accountable Care Organizations published in the Wall Street Journal has received extensive attention. The 302 comments following the article far outweigh the number of words published in the original post.

This opinion piece was short on facts, long on assumptions, required three writers to draft little more than one thousand words.

Healthcare professionals know that there is far more substance and nuance to the current state of health IT innovation and accountable care.

Rather than speculating from the Innosight Institute’s think tank (where two of the three authors of the Wall Street Journal article sit), the “boots on the ground” facts that appear to contradict the sweeping claims made in that opinion piece, or otherwise convey the significant achievements of accountable care, shall be herein reported.

The term accountable care organization was first used in 2006. It was an idea that gelled quickly, reaching peak popularity in 2009.  Beginning in 2011, the CMS Pioneer ACO program began in earnest, setting out with a five-year $1.1 billion cost-savings goal.  CMS hopes to secure Medicare patient health improvement and cost-savings objectives, and will reward participating ACOs who satisfactorily achieve financial and quality measures across 33 different criteria.

Dr. Steven Bernstein, Assistant Dean for Clinical Affairs at the University of Michigan with an internal medicine background, presented his health system’s work during his keynote panel presentation at the Fall 2012 Health IT and Accountable Care Strategies Summit in Chicago, with “a more clinically oriented approach to the issues.“

In his portion of the keynote panel, Dr. Bernstein reported “The University of Michigan Health System sees 1.7 – 1.8 million outpatient visits per year.  47,000 hospital admissions. 18 primary care centers.  27 certified patient centered medical homes.  10,000 staff.”

As a clinician in charge of operations improvement, Dr. Bernstein worked with Medicare as a physician group practice (PGP) demonstration project, from 2005 to 2010 to see if physicians could “bend that curve” and reduce the cost of healthcare.

“We were successful,” reported Dr. Bernstein, saving money for Medicare in all five years of the program. In total the PGP saved Medicare $22 million and brought $17 million back to the health system, demonstrating particular skill at trimming costs among, “dual-eligibles,” the very sickest of patients.

University of Michigan Health System was one of the 32 Pioneer ACOS and launched with the initial group under the CMS program.

“My group focuses on quality performance and outcomes…. It would be great if we were more integrated, but we’re not at this point.”

Rule 2 of Meaningful Use for the CMS Electronic Health Records incentive program is designed to engage patients with health IT-powered portals, much in the way the authors of the WSJ piece call for “more widespread use of telehealth.” The EHR incentive program has spent more than $10 billion thus far saving time, space, and energy by eliminating paper medical records, and bringing electronic health records into tens of thousands of physicians’ offices all across the country.

The WSJ attack on the accountable care transition was limited in scope, political in nature, and academic in misunderstanding.

The reality is that the Affordable Care Act is helping doctors build out EHRs, bringing health connectivity to rural areas, and challenging medical professionals to integrate technology into their practices in both one-on-one settings, as well as macro-level population management settings.

Along each point of care, health IT is changing the shape of healthcare in the US, albeit at its own deliberate pace.

With advances in machine learning, recently reported at Indiana University, the need for ACOs remains as pressing as ever.  While best practices are still being developed and hospitals and health systems around the country are implementing solutions on different respective footings, the spiraling cost of care in the US demands that both doctor and patient behavior begin to change.  Currently they are, and given sufficient time, they will.

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