The year is almost certain to end with Congress repealing the individual mandate for insurance coverage, but unable to agree on new measures to help contain healthcare costs or to improve quality.
But that's certainly not the end of the story. Those of us on the front lines are moving ahead anyway, finding new ways to deliver high-quality and cost-efficient care.
The mission is essential: While the increases in healthcare costs have slowed, they still outpace economic growth. Care can be fragmented. Quality is not always consistent. There's too much variability in diagnostics and treatment, which can increase costs without improving outcomes. We must align our goal of making healthcare more affordable while providing high-quality care and an enhanced patient experience at the optimal price. It's the holy grail of healthcare reform.
We remain convinced that accountable care organizations and patient-centered models are effectively moving the needle on cost and quality in the shift away from traditional fee-for-service medicine and are worthy of expansion—even as they experience growing pains.
Today, about 1 in 5 Medicare beneficiaries, or more than 10 million people, receive care through an ACO. These organizations are reporting real progress on most quality measures, outperforming their fee-for-service counterparts.
More than half of ACOs in the Medicare Shared Savings Program generated savings in 2016—a rate higher than the CMS has ever reported. And the longer an ACO has been in the program, the greater the savings. One ACO in Hackensack Meridian Health's 13-hospital network climbed to third in the nation in just a year and increased savings from $33 million to $50 million.
Insurers, too, are reporting dramatic growth in enrollment in patient-centered plans, hitting that sweet spot of fewer hospitalizations, more cancer screenings and cost savings.
With any evolving system, especially one to refocus national healthcare, there are predictable kinks. Strong quality performance does not always predict significant savings. We need more research to decipher why some models—especially those that are physician-led—are more successful than others. And there's no guarantee this is necessarily a long-term solution.
But it's well-documented that the ACO model encourages physicians to move toward a patient-centered model, approaching care in a longitudinal fashion, as opposed to a transaction between patient and provider. The focus is on health, not just connecting in illness. It's about providing the right care at the right place and time.
Expanding this model is essential as the nation's 76 million baby boomers continue to retire. Today, about half of all adults have at least one chronic condition, the most costly and preventable of all health problems. What happens when the senior population doubles by 2050?
Beyond ACOs, healthcare leaders across the nation are banking on demonstration projects to transition the system from volume to value, including bundled payments, shared-risk arrangements and value-based purchasing. These programs are not mutually exclusive. They can be collaborative. Our network and many others are working to marry these strategies to ensure ongoing financial survival while improving outcomes as well as the patient experience and lowering costs.
But rather than academic explanations, how are these strategies benefiting patients?
We enrolled a 75-year-old grandmother diagnosed with congestive heart failure in an ACO after repeated hospitalizations. Within a few months, she was well enough to drive across country with her husband to visit her grandchildren.
In oncology, we developed a digital classification system that helps personalize treatment and track cost. We found that by performing a genetic test for certain breast cancer patients—which costs $4,000—we could save $11,000 on average because we learned that not all patients would benefit from chemotherapy versus alternative therapies.
Healthcare networks across the nation must continue to respond with a fierce sense of urgency to redesign the way care is delivered. Together, we can truly revolutionize the future and push the boundaries of medicine to create real change in people's lives—and ensure the sustainability of our system.
