Are Accountable-Care Organizations the Answer?

One of the ways in which the Affordable Health Care Act hopes to bring health care costs down is through the establishment of accountable-care organizations, or ACOs. In an ACO, hospitals or groups of doctors who contract with insurers to provide care for an assigned patient population are rewarded for keeping patients healthy by being able to share in the savings.

 

According to government data, one percent of patients nationwide account for nearly 22 percent of health spending, and these are the patients most targeted by ACOs. Many of these people suffer from chronic health conditions and lifestyle issues—such as transportation and housing problems – that make it difficult for them to take care of their health. As a result, they may not keep doctors’ appointments or take medication as directed, resulting in the use of ambulance services and emergency room visits any time a serious medical issue takes place.

 

In a perfect world, ACOs would do more than just hold down costs; they would also provide extra services such as checkup reminders, screenings and management of chronic conditions. But as it stands now, ACOs still need a lot of work; patients can bypass the system by visiting other hospitals out of their accountable-care organizations, and the ACOs themselves still pay doctors for services even if costs are not cut, while sharing in savings if costs are lowered.

 

It also costs money to create an ACO; hospitals can spend millions to improve data communication systems and hire care coordinators to work with patients. These costs are not reimbursed by Medicare, making it even more expensive for health professionals to commit to the program. To date, more than 250 health systems have signed on to participate in a Medicare pilot ACO program, and the results are mixed. While final first-year results won’t be known until 2014, out of 32 ACOs studied, all met the ACO quality criteria, which includes cancer and depression screenings and scoring well on patient satisfaction surveys – but only 13 lowered costs enough to split the savings with Medicare. However, there are health care organizations that have systems to improve patient compliancy, which eventually improves patients’ conditions and reduces costs.