Accountable care organizations, a fashionable name for a loosely defined fix for U.S. healthcare, are the center of debate, gossip and conjecture among policymakers and the healthcare leaders.
But the murky state of the model and poorly received draft regulations intended to clarify the sketch included in the healthcare reform law have not deterred plans among some hospitals, medical groups and payers to make accountable care something real, rather than mere aspiration.
Indeed, the results of Modern Healthcare's first survey of accountable care organizations provide a snapshot of 13 accountable care organizations in the wild that executives say could reduce medical errors and waste with financial incentives for quality and lower costs.
They include everything from fledgling alliances to detailed agreements. Some already track quality and spending under contracts with commercial insurers. Others have yet to complete physician arrangements. A few have poured capital into ancillary businesses.
The wide-ranging mix of initiatives is no accident; accountable care emerged from the nation's health reform debate as a largely untested and loosely prescribed option to overhaul hospital and physician payment and delivery.
But as health systems, medical groups and other providers scramble to draft strategic plans and capital budgets around a working model of accountable care, such uncertainty could prove an advantage or significant risk.
Dr. Elliott Fisher, director of the Dartmouth College Center for Population Health and a proponent of accountable care, said some flexibility is needed to allow the model to take hold across the highly fragmented healthcare industry.
Accountable care, Fisher said, offers financial incentives for hospitals, doctors and other providers to more closely coordinate medical care.
Markets with competitive or highly independent providers would likely need more time and options to develop accountable care than large health systems with an existing network of employed physicians, he said.
Providers who agree to join these endeavors are vulnerable to costly missteps that could put finances and patients at risk. “Organizations will come together and try things, and they will encounter resistance and make mistakes,” said Sara Singer, an assistant professor of health policy and management at Harvard University School of Public Health.
Some mistakes will be significant, including a failure to manage financial risk, as was the case during the managed-care expansion during the 1990s, Singer and health policy expert Stephen Shortell wrote this month in the Journal of the American Medical Association.
“The important thing is to learn from those mistakes,” Singer said.