Paper on Accountable Care Organizations

The health care world is abuzz with various developments designed to improve access and quality and control health spending; many supported by the recent health law as well as private initiatives.  One of these developments is the notion of the accountable care organization, which is envisioned as a system of providers which takes overall responsibility for a patient’s care, usually the quality and supposedly the cost as well.  In their most mature and sophisticated form, these would essentially be risk-bearing entities.   Computer Sciences Corporation works in the health care information world and has issued a brief describing the kinds of health IT needed to support ACOs.   (CSC Paper)

The paper lists six primary ACO functions:  member engagement; cross-continuum care management; clinical information exchange; quality reporting; business intelligence and analytics and risk and revenue management.  It then describes the information systems support necessary for each of those functions.  Two critical ones which will be particularly difficult are the ability to ensure real-time sharing across all providers of relevant clinical information and care plans and the ability to manage at-risk payments and share revenue among the providers in the ACO.  Neither is a trivial task and few provider organizations have these capabilities today.

The more you think about ACOs, the less sure you would be that you need them.  If you read what they are supposed to do, most health plans in essence do it already.  Why create another layer?  Maybe people think providers will feel more engaged if they are directly at risk, especially financially.  But that assumes that ACOs will include some form of set global payment, which may not happen.  The Medicare demonstration doesn’t complete this at all.  And even if there is a global payment, given their market power, the providers in an ACO are likely to insist on high reimbursement and significant increases each year.  So ACOs, even if necessary, may improve care coordination some, but they won’t likely control costs.  And all the IT they will need to support themselves will just be one more justification for demanding higher payments.