New approach to health care management still faces questions

Five years after the passage of The Patient Protection and Affordable Care Act, designed to change the way health care is delivered and paid for in the United States, accountable care organizations remain an unproven approach to tying payments to lower costs and quality care. Then again, the model hasn’t been disproven either. Growth in the number of organizations was significant. Results have been mixed.

“I don’t know what people’s expectations are. Maybe the president oversold it. Maybe we have too much negativity in this country,” said Jonathan Gordon, director of the office of strategy at New York-Presbyterian Hospital, on a panel about accountable care organizations at the Feb. 20 MIT Sloan BioInnovations Conference.

Accountable care organizations have formed across the country in the years since Congress passed the bill, which encouraged the creation of such groups to serve Medicare patients. The payment model varies, but in all cases there is emphasis on coordinated care, quality and performance metrics, and cost savings.

Whether it works and where it works best is still up for debate. There was some agreement on the four-person panel that success so far has come from providers with the most room for cost savings, those in dire need of more efficient operations, and small doctors’ groups with the capital to undertake rapid, significant change.

“It’s nice to work with physicians and groups … that aren’t performing well right now when you enter into these ACOs,” said Jeb Dunkelberger, director of accountable care services at McKesson, a Fortune 500 drug distributor and health care technology company. Those are easy wins, he said.

Dunkelberger said he works to establish accountable care organizations with providers that have significant capital support. Success there, he said, may produce rules and lessons for other organizations.

“It’s no secret that you need a large amount of capital to go after something like this appropriately,” Dunkelberger said. “One of the things I constantly preach is that you can’t be cheap going down this route.”

Technology, analytics critical to success

To build an accountable care organization, providers must have robust back-end systems, invest in patient management technologies, participate in universal electronic medical record adoption, and take advantage of technologies that improve efficiency, such as remote patient monitoring and virtual visit software, said Dr. Sree Chaguturu, vice president of population health management at Partners Healthcare. At Partners, where Chaguturu helped to implement an accountable care approach, data and analytics tracking has reduced patient stay times and improved efficiency elsewhere, he said.

But most hospitals and providers are far behind on using those technologies, said Mikki Nasch, co-founder of The Activity Exchange, which makes big data and analytics software for the health care field.

Partners is a large health care organization, so practiced in coordinated care that it was named a Medicare Pioneer organization, a fast track for transition to the accountable care model. Not every provider group has the same resources or experience.

“The question in every organization that decides to do accountable care is ‘How fast do we make that transition, if at all?’” Chaguturu said. “There is no playbook for ACOs.”