Accountable care organizations are trying to piece together a broken health care system in the dark, according to Barak Richman, JD, PhD, professor of law and business administration at Duke University.
Early efforts to coordinate ACOs included pay-for-performance reforms, but these changes have fallen to the wayside as the Medicare Shared Savings Program gives ACOs the option to largely continue with fee-for-service payments. Meanwhile, market consolidation is causing healthcare prices to rise and the integration success of Kaiser, Geisinger and Intermountain are more anomalies than norms, Dr. Richman wrote in the Harvard Business Review.
Dr. Richman suggested the following five strategies for ACO success:
- Rethink the ACO concept. Rather than emphasizing the connection between hospitals and providers, ACOs should instead take the bottom up approach: link providers with consumers and payers to focus on the patient's needs and budget, Dr. Richman says.
- Give nontraditional parties the support needed to get involved. Social workers, IT companies and health system navigators have the experience to help lead patient-focused care networks.
- Collaborate on contract-based agreements and with virtual providers instead of mergers. Fully using EHRs may reduce the need for high-cost integration.
- Consider disruption. Outsiders often provide the best innovations, Dr. Richman says. Technology companies are beginning to provide improvements that should not be ignored.
- Continue to push for payment reform. It will be easier to assess reform if ACOs are actually accountable to consumer demand, according to Dr. Richman.
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