Accountable care works

November 11, 2014

In the accountable care model, providers are rewarded for taking steps that produce the best results. Accountable care requires putting the primary care physician at the center, where he or she can focus on the patient’s overall health by coordinating care with other providers.

There are many engaging debates about the ways we can improve the healthcare system: Telemedicine, the Affordable Care Act, and electronic health records.

One of the more important, but less-known initiatives also has the potential to truly impact the healthcare system: accountable care.

Challenge is opportunity

Most of us know the benefits of accountable care, a healthcare delivery approach that focuses on improving patient outcomes, quality and cost. It’s widely seen as a superior method for structuring healthcare than the traditional model, known as fee-for-service.

In the fee-for-service system, physicians earn more money by ordering more procedures and the patient’s ultimate health outcome isn’t a factor in the provider’s compensation formula. It is also widely accepted in the medical community that fee-for-service has contributed to problems of over-treatment for some patients, resulting in increased costs.

It delivers results

Many providers are entering into these value-based agreements, yet we still have a long way to go. How do we help providers transition from a fee-for-service model to an accountable care model? Start with results. In my 20-plus years of experience as a medical oncologist, I have seen firsthand that a value-based approach is beneficial for everyone involved, physicians, patients and insurers. The Medicare Advantage program, where health coverage companies operate under an accountable care model, has led to better health outcomes at a lower cost than traditional Medicare.

In the accountable care model, providers are rewarded for taking steps that produce the best results. Accountable care requires putting the primary care physician at the center, where he or she can focus on the patient’s overall health by coordinating care with other providers. This can help prevent duplicative procedures and tests and also ensure one prescription medication isn’t negatively interacting with another.

It takes commitment

Providers must understand that you get out of accountable care exactly what you put in. It requires increased collaboration between doctors and health coverage companies that process claims data and may have information (ER, urgent care visits) that the patient’s primary care physician might not be aware of otherwise. This helps address gaps in care that are all too common in the fee-for-service system.

This cooperation can also mean that a patient not only gets treatment for the cold that ails her today, but also a flu shot to keep her healthy in the future. Likewise, patients with colon polyps receive colonoscopies and those with diabetes receive regular eye examinations.

When practitioners are held accountable for the health of the people they treat, engagement with patients goes up; there is greater trust, and a greater likelihood for healthier outcomes.

It’s a new world

I spend a great deal of time thinking about how to help consumers change their behavior in order to achieve their best health. A consumer-centric, accountable care approach to providing and managing healthcare will foster a patient/physician relationship that can help modify unhealthy behaviors that result in chronic diseases.  

For patient care to be effective and affordable, it must also be accountable. Accountable care not only will improve our healthcare system, it’s also inevitable. Its implementation will require a continued adjustment, certainly, but it’s one we need to make. If we do it right, we’ll improve the health of our patients and our long-ailing healthcare system for generations to come.  

Roy Beveridge, MD is chief medical officer at Humana and serves on the Editorial Advisory Board of MHE.