American Health Care Without Accountability

By Francis J. Crosson, MD, chair of the Council of Accountable Physician Practices
Senior fellow at the Kaiser Institute of Health Policy

The accountable care organization (ACO) was conceived as a model for improved care delivery that would provide value to the American health care system by improving quality and controlling cost. The model is being considered and piloted both for Medicare and for non-Medicare commercial health care services. However, ACOs — and specifically, the Medicare Shared Savings Program — have come under criticism from providers, health plans, hospitals, regulators, and policymakers alike.

Much of the criticism is valid (in fact, we will look at some of the specific criticism in future columns on this website). And many of the concerns are being addressed by CMS and others. However, it is my opinion that none of the expressed concerns should prevent the evolution of the ACO model, because, frankly, what’s the alternative? What happens next if the accountable care organization idea fails?

Let’s think about it: looking  past issues of ACO structure and payment design,  and even to trying to ignore current political disagreements about the Affordable Care Act, if ACOs prove their value in improving quality and moderating cost increases, then the future for American health care will look good. Improving the health of a population, the experience of care by the people in this population, and the cost per capita of providing care for this population will be feasible.

But if ACOs fail and are not allowed the chance to prove their value, then we are looking at a bleak future:  public and private payers may be forced into across-the-board reductions  in payment rates to providers (similar to the “default” position proposed for the new  bipartisan congressional debt reduction committee), because there will be no other obvious course  to pursue in the effort to bend America’s health care cost curve. If that happens, we may see consequent reductions in quality and access. In an attempt to make up for lower payment rates, providers will likely continue to increase the volume of services and will not be motivated to take accountability for population health and costs.

The nation will lose a lot if we do not seize this moment and support the evolution of ACOs, payment for value, and provider accountability for the cost and quality of care for a population of patients. Rather than succumb to self-interest and fear, and resist change, we need to stand firm in our belief that it is in our common interest to see that ACOs succeed and can make good on its promise. A high value, effective, and efficient health care system for our country will benefit us all.

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