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ACOs are here to stay – Whatever the Court decides

We’ve seen for decades now that paying doctors and hospitals for each individual service they provide (“fee-for-service payment”) does not create an efficient or effective healthcare system, in turn driving up costs. And, it encourages healthcare organizations to pursue high margin services that treat illness, rather than invest more in keeping people well. The result is a fragmented system of sick-care, with little incentive for providers to coordinate care or prevent illness.

{mosads}ACOs are a means to flip this sick-care system on its head – to pay for quality of overall care in a coordinated system. The ACO model is built on shared accountability. If providers meet predetermined quality measures, and care costs for a specific population are lower than was budgeted, then (and only then) do providers share in a portion of the savings.

As an example, consider a 65-year-old woman with congestive heart failure and diabetes. When she does not feel well, she goes to the emergency room and usually ends up being admitted. With an ACO, she would receive additional support to manage her conditions to avoid problems. Based on knowledge of her condition, a change in medication might eliminate a hospital visit.

Innovative organizations have been functioning like ACOs long before the term was coined. As a practicing internist and cardiologist for 40 years, I have worked under a global payment system successfully for my entire career. I have seen how our patients experience the benefits of ACOs every day in a trusted doctor-patient relationship, with access to teams of experts, and coordination among specialists and hospitals. I have seen how a strong base of primary and preventative care can improve quality while lowering costs; for example in 2010, my organization decreased cost growth against prior trends for our commercially insured patients by $64 million while increasing overall quality.

The ACA’s emphasis on coordinated, preventive care is something that will not end if the law is struck down in the Supreme Court ruling. While law accelerated formation of ACOs, leaders in healthcare are also moving full speed ahead. The CMS innovation center launched a second initiative of 27 new ACOS in early April. Meanwhile, new commercial ACOs are announced each week. The signals are clear that ACOS are moving forward on many fronts. Throughout the country, the Pioneer ACOs have become a model for the future of comprehensive patient care.

Skeptics say that ACOs sound too much like 1980s-style managed care that fueled widespread reports of skimping on care or that the Supreme Court’s ruling on the ACA will have a negative impact on ACOs. But the landscape has changed entirely. We now have information technology and incentives to ensure that appropriate care is provided, the ability to measure aspects of quality across providers, and ways to measure patient experience and outcomes. And, with federal officials projecting that the 32 Pioneer ACOs will save up to $1.1 billion over five years, the country can’t afford to ignore the benefits of the ACO model.

The ACO concept is filled with possibilities. Experience and new technologies are moving us along a sensible path of coordinated, patient-centered care – one that rewards accountability, quality and a shared interest in keeping patients healthy.

Regardless of the Supreme Court decision, ACOs are here to stay.

Dr. Lindsey is president and CEO of Atrius Health, an alliance of six community-based medical groups in Massachusetts and its largest affiliate, Harvard Vanguard Medical Associates.


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