Show Coverage: Delivery models must transform

June 16, 2011

Collaboration is the driving force behind accountable care organizations (ACOs), a strategy that requires a partnership among a diverse set of stakeholders?providers, payers and purchasers.

Collaboration is the driving force behind accountable care organizations (ACOs), a strategy that requires a partnership among a diverse set of stakeholders–providers, payers and purchasers.

“ACOs represent a model offering the opportunity for the three constituents to reduce costs and improve quality, a concept that moves away from a fragmented fee–for–service environment and payment for volume of services to one with shared risk and savings and outcomes–based care,” said Bill Shea, partner, Healthcare Business Consulting for Cognizant, one of the panelists at a Thursday session on delivery model transformation.

Although a perspective from another important partner in an ACO-the hospital-was missing from the discussion, Shea said that these providers often serve as key facilitators in developing an ACO and are able to bend the trend through collaboration.

Panelists explored the operational elements of an ACO, including financial, organizational, care management and approaches to information technology.

“We need to develop the appropriate business structure to manage significant risk and align incentives among all parties,” he said. “By doing so, we anticipate a 0% spend trend, which early evidence has supported.”

At the heart of the ACO is the ability to integrate resources and information to provide care across the entire outpatient and inpatient spectrum–supporting outcomes–based payment systems, developing patient registries and master patient indexes and feeding the electronic medical record.

Shea isn’t convinced, however, that ACOs necessarily will hit a home run on their first step up to the plate.

“Information technology and developing the ACO infrastructure might very well stand in the way of the new models,” he said.

Shea also pointed to the challenge of assigning specific populations to ACOs, which can be critical in delivering on managed care concepts that have worked, providing population health and lowering variability of care among providers.