Everyone knows what unicorns look like.
You know, unicorns: well-brushed manes, thick cords of muscle, magical horns on their forehead. No one has ever seen a real one in flesh and blood, yet somehow everyone knows how it would appear if they did.
The same is true of accountable care organizations. Everyone—including the federal lawmakers who crafted the healthcare reform law—thinks they know what an ACO is basically supposed to look like. How many people have actually seen one, though?
This was the analogy offered by healthcare futurist Ian Morrison at the American Hospital Association's 18th annual leadership summit in San Diego July 22-24. (Morrison later admitted he borrowed the comparison from California HealthCare Foundation President and CEO Mark Smith.)
The unicorn-ACO comparison is, of course, a pejorative one. But for an idea that's supposed to hold the promise of revolutionizing healthcare finance, ACOs had no shortage of detractors and skeptics at the AHA meeting, both in public talks and hallway conversations.
“I defy anyone to define it,” said Martha Marsh, president and CEO of Stanford Hospitals and Clinics, commenting on ACOs as part of a panel on transforming healthcare for greater value.
Marsh's comment came in the context of a general warning to hospital leaders to stay away from fads while also keeping eyes open to new ideas, particularly those that other hospitals are trying with success. “The industry needs to get more innovative and nimble. We've built a culture that is slow to change,” she said.
Her comment was followed several minutes later by one of the most quotable lines of the entire meeting.