“No one change by itself is going to be enough,” McClellan told participants at the conference, sponsored jointly by Brookings and the Dartmouth Institute for Health Policy and Clinical Practice.
That’s not the message Democrats trumpeted during the healthcare reform debate.
ACOs are a cornerstone of the Democrats’ health payment reforms. The model is designed to move the nation’s troubled healthcare system away from the current fragmented approach, in which primary care doctors, specialists, hospitals and clinics might all treat the same patient without communicating. That “silo-based” system, critics say, creates redundancies and inefficiencies that push up healthcare costs.
ACOs, by contrast, were sold as the vehicles that would coordinate payment and care delivery among Washington, the states and private industry. No one dares suggest what the model should look like, McClellan warned, because “that’s just not where our country is right now.”
Complicating the transition to the ACO model, patients are at least as confused about the switch as providers, said Elliott Fisher, who heads Dartmouth’s health policy institute.
The experts recommend that the White House establish clear cost, coverage and error metrics so that providers know precisely what they’ll be judged on. But they also warn the administration not to be too specific on what the ACO model should look like.
“We don’t have evidence yet about what features are necessary,” said Aaron McKethan, director of health IT at the Department of Health and Human Services.