For Robert Pearl, M.D., accountable care-a delivery model in which providers are rewarded on outcomes, not volume-is an idea whose time has come.
"Health care is fragmented and it resembles a 19th century cottage industry more than an integrated delivery system," says Pearl, chairman of the Council of Accountable Physician Practices, an offshoot of the American Medical Group Association. Doubling as CEO of the Oakland, Calif.-based Permanente Medical Group, Pearl says the council's 30-plus large group practices-spanning such disparate locales as rural Montana and urban Massachusetts-face multiple common challenges in fulfilling the care coordination underpinnings of accountable care.
It's a model in which providers may be at risk for the so-called "total cost of care," meaning all services delivered to patients across the multitude of settings-the physician office, the emergency department, the hospital, the rehab facility and the nursing home, among others.
Four key factors underscore the challenge, Pearl says. First is the lack of overall structural integration. "The physician has his own office and they have a collegial relationship with other providers, but typically patients maintain multiple physician relationships," Pearl says. "You need a structure to pull these people together." Second has been an historic absence of economic incentives to reward providers on outcomes, Pearl says. That is changing under the ACO model, in which health systems can receive bonuses for delivering better outcomes and avoiding readmissions, if not hospitalizations themselves. The I.T. requirements are a third barrier, Pearl says. "If you can't exchange information rapidly and follow the patient from inpatient to outpatient and back, it is very difficult to coordinate care." The final challenge-and most critical, Pearl contends-is establishing leadership by physicians, "as opposed to accountants," to drive and lead the effort.
In the July issue of Health Data Management, Gary Baldwin’s latest update on accountable care organizations summarizes work done and lessons learned so far at four ACOs.
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