Accountable care organizations could be key to containing costs under health reform. Doctors’ practices, clinics and hospitals would work together as one organization and and meet all the health needs of a group of patients. The ACO also takes responsibility for the total cost of care and the quality and effectiveness.
The Commonwealth Fund just released a report on an ACO pilot in Vermont
What did they find? A lot of pieces need to be in place for an ACO to work. The report gets a little jargony. For a slightly less technical explanation, see this state powerpoint.
And, for more on Vermont’s ambitious “blueprint for health reform,” click here.
The new report concludes that ACO pilots need to have threshold capabilities in five areas to get started:
First, the ACO must be able to manage the full continuum of care settings and services for its assigned patients, beginning with a patient-centered medical home approach to primary care.
Second, it must be financially integrated with both commercial and public payers, and all payers need to participate, so that at least 60 percent to 70 percent of patients in a provider’s practice can be eligible for inclusion in a shared-savings model.
Third, a health information technology platform that connects providers in the ACO and allows for proactive patient management is essential, along with a strong financial database and reporting platform for managing the global medical budget.
Fourth, physician leadership, as well as the commitment of the local hospital CEO and leadership team, is vital to driving changes in process, cost structure, and mission.
Finally, it must have the process improvement capabilities required to change both clinical and administrative processes to improve the ACO’s performance so that it can achieve its financial and quality goals