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Promoting accountability in ACO - A few insights (Part 1)

In a successful Accountable Care Organization (ACO), establishing and sustaining the exchange of information flow among the individual constituents matter the most.

The term accountable care organization (ACO) was coined in the Medicare Shared Savings Program as part of the Patient Protection and Accountable Care Act of year 2010 (PPACA). The program, anchored by the Centers for Medicare & Medicaid Services (CMS), will share annual savings for a population of Medicare beneficiaries with a group of providers who form a provider organization that meets the defined criteria. Such groups are called accountable care organizations (ACOs).

Consider a few situations in an ACO where the participating providers diagnose the same disease differently, prescribe additional or different procedures if diagnose the same patient, do not consult patient's medical history during diagnosis. In such cases, the patients will not receive the cost effective quality care.  In a recent letter issued to CMS, AHIP had raised the concern that "The antitrust agencies should modify their proposed antitrust policy statement to minimize the potential risk of increased prices due to provider consolidation". This can be very easily misconstrued as the monopoly of the large provider group. If we look from other side, it could very well be because the providers are working in silos even though they belong to one ACO and there is a big gap in exchanging the clinical information.

Is ACO thus limited to just consolidation of providers or there is something more to it ? In my point of view, two critical factors which will ensure a proper functioning of ACO -

• Adherence by the individual constituents to a central theme of improving quality of care through innovative practices and collaboration
• Establishing a standard way of performing the clinical practices across the ACO organization

We will be deliberating on these two topics in the next series of blogs.

Coming to the first topic i.e. Adherence to a central theme, the questions that quiz me:
1. How to ensure collaboration among the stakeholders which will result in the patients getting the right and cost effective treatment
2. How will the collaboration exceed the boundary of each individual participating hospital to the level of the accountable care organization

To me, the major roadblocks in ensuring collaboration are the lack of defined processes and supporting systems and a right attitude from the provider. The simple example would be a patient visiting different doctors with the diagnosis and medication information not being shared among the doctors. This might result in duplicate procedures resulting in higher costs.  The medicines prescribed by doctors can create side effects due to lack of knowledge of other medication being taken by the patient. A process needs to be established which will keep track of a patient from the minute of entry to a provider facility to the diagnosis phase. All the medical test results and prescriptions need to be made available on demand. The doctors need to make every attempt to understand the patients by thoroughly looking at the patient history including patient genetics. This is achievable if the providers change the mindset which is caring for volume without looking at the quality of care. The ACO organization must enforce this through a central focus. Building provider awareness is the key. And all these are not achievable by the providers manually and there is a need of robust infrastructure to support.

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