What is an ACO?
Here is a recent example of an ACO definition taken from a 2010 article co-authored by Elliot Fisher:
ACOs consist of providers who are jointly held accountable for achieving measured quality improvements [note that “measured quality improvements” is synonymous with report cards] and reductions in the rate of spending growth. Our definition emphasizes that these cost and quality improvements must achieve overall, per capita improvements in quality and cost, and that ACOs should have at least limited accountability for achieving these improvements while caring for a defined population of patients.
ACOs may involve a variety of provider configurations, ranging from integrated delivery systems and primary care medical groups to hospital-based systems and virtual networks of physicians such as independent practice associations. All accountable care organizations should have a strong base of primary care. Hospitals should be encouraged to participate, because improving hospital care is likely to be essential to success. But in contrast to others’ definitions, we believe that this need not be an absolute requirement for all ACOs (Mark McClellan et al., “A national strategy to put accountable care into practice,” Health Affairs 2010;29:982-990).
Hmmmm....confused enough? Well, in my ongoing quest to simplify or "Englishify" everything, I'll take a stab at it in my own way. The basic premise of an ACO is this:
1. Improve Quality of Care
2. Reduce Cost
3. We will hold you accountable for 1 and 2. Simple enough? Not so fast....
Someone once told me, "if you ask a question once, you might look dumb. But if you don't ask it, you'll stay that way". So here are the questions:
1. Who is going to hold you accountable? (Let's say CMS)
2. How are they going to hold you accountable? (Let's say they come up with measures that you have to track and report)
3. Define "defined patient populations"? (This my friends, I have no idea what it means)
So my real question is, if they do come up with the answers to the questions above and define ACOs, is it an achievable goal? The answer is, Absolutely! Improving quality of care while reducing cost of care is a very achievable goal. In fact, you should do it before they make you do it! The technology exists today. All you have to do is take one look at our KnowledgePath report and go home happy knowing that you have the technology and reporting capabilities available at your fingertips.
