The Barriers to an Accountable Care Organization

In multiple health care-related journals over the last several weeks, readers viewed numerous articles as well as invitations to attend conferences to learn more about “accountable care organizations” or “creating high-performing care organizations.”

This new terminology, Accountable Care Organization, or ACO, is one of the critical efforts in the recent health care reform law that is proposed to reduce the cost of health care in the U.S. It is predicated on the belief that well-coordinated, integrated care will be more likely to increase quality of the outcomes while reducing costs in comparison to the often-fragmented care which is experienced by our patients today. This clearly makes sense to providers of care, and yet it is not the norm in medical practices today. What are the barriers that keep well-coordinated, high-quality, cost-effective treatment plans from being implemented across he care continuum? What barriers will CHRISTUS Health face in building its aggregator model, one of our five strategic directions on its continuing Journey to Excellence?

The first, and perhaps most, significant barrier is our current fee-for-service payment system. This system has unfortunately incented most providers to perform as many procedures and treatments as possible, repeating studies and tests that have been done elsewhere which, if results were obtained, would not need to be repeated.

The second barrier is that coordinating care which is personal, safe, accessible, reliable and efficient often takes time. To connect the dots between multiple points and providers rendering services to a patient on a health care journey requires phone calls, immediate completion of records so a patient can carry them from point A to point B and timely transfer of treatment plans to the next provider so studies/tests are not duplicated.

A third barrier is the educational experience of most providers, which has focused on individuals rather than a population health management model. The former focus often provides individual treatment plans with variability in quality and costs, while the latter focuses on more consistent processes which minimize duplication and rework, and maximize repeated learnings which encourage rapid-cycle improvement.

Yes, the logic behind ACOs make sense, but to make them successful, strategies must be put in place to knock down the barriers which are real and visible in U.S. health care today.