One of the fatal flaws of proposed accountable care organizations, according to some critics, is that they aren’t designed to support physician behavior change at the scale that’s necessary to make the movement a success.
On the contrary, Premier healthcare alliance, a provider-owned performance improvement alliance of 2,800 hospitals, believes physicians are the driving force of ACOs. During an ACO summit in Cleveland earlier this week, two leaders within the organization talked with MedCity News about overcoming challenges with ACOs.
“Most physicians I talk with think the current system is broken, and they’d like to go to a different system,” said Joe Damore, a former health system CEO and vice president of Premier consulting solutions. “They also like the idea of being rewarded for delivering quality care and for keeping people healthy. So, many primary care physicians think this model is the right directions.”
A bigger challenge lies in inspiring change in specialists, whose incentives are procedural-based. This is where bundled payment can really make a difference, Damore said. “We think bundled payment is very good for orthopedics and cardiologists to help create an environment where (they) benefit by putting in clinical protocols and care management systems for things like total joint (replacements), where they can participate in the economic benefits of reduced complications and reducing costs.”
The Centers for Medicare and Medicaid Service launched its Bundled Payments for Care Improvement Initiative in January, and more than 100 healthcare organizations across the country are testing four different models.
Reimbursing a team of physicians for an entire episode of care, rather than each of its individual pieces, will also inspire innovators to think of the most efficient ways of doing procedures, and the quickest way of helping patients get better. “There’s no incentive to innovate currently when everyone’s just thinking about their own piece,” said Blair Childs, senior vice president of public affairs for Premier. “Think about what that creates in the way of incentives.”
To get to that point, though, there’s going to have to be massive physician training across the country, involving a community of outspoken physician-leaders talking to their peers, Childs and Damore said.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Other critics of ACOs point to the failure of managed care models in the 1980s and 1990s as a sign of what’s to come. But Damore said a few things are different this time around. For starters, the economic challenges the country has faced in the last decade are a clear demonstration that the current healthcare system is not sustainable. “I don’t run into anyone anymore who says, ‘The current system is great, leave it alone,'” he said. “The second change is that we’re trying to align the change in care with a change in the payment method, which did not happen before.”
[Photo Credit: Expensive healthcare from BigStock Photo]
