Value-Based Care News

Accountable Care is Not a New Concept

By Ryan Mcaskill

The term Accountable Care Organization was coined in 2006 but the history of accountability in healthcare in much longer.

- One of the hottest trends in the healthcare landscape is accountability. Following the Affordable Care Act, a focus on value-based care has been created with Accountable Care Organizations leading the way. In this concept, participants agree to be accountable for a population of patients and agree to share in terms of care delivery and risk sharing.

Inclusion in the Affordable Care Act has increased the value of Accountability, but it is not a new concept. An article from the Annals of Internal Medicine from January 1996 asked the question, “What is Accountability in Healthcare?” Written by Ezekiel Emanuel MD, PhD and Linda Emanuel MD, PhD, the piece outlines the need for more accountability in healthcare in the aftermath of President Bill Clinton’s Health Security Act.

They advocate for multiple models of accountability being required. This is because, different models stress different domains, evaluative criteria, loci and procedures.

“A domain of accountability is an activity, practice, or issue for which a party can legitimately be held responsible and called on to justify or change its action,” the article reads. “Accountability in healthcare consists of at least six domains; professional competence, legal and ethical conduct, financial performance, adequacy of access, public health promotion and the community benefit.”

The idea of accountability is clearly not new, but it has evolved. What the article laid out is adding more accountability to healthcare across the board. The idea of domains has been replaced with the Affordable Care Act and payment platforms like Accountable Care Organizations.

These platforms also share similarities to Health Maintenance Organizations (HMO), which have been around since the 1970s. However, it differs in that an HMO is insurance-led, while accountable care is provider-led. This is also a belief from some industry experts like Thomas Tsang, that HMOs have been putting up walls in terms of patient options, while ACOs are helping to knock those walls down.

New age of accountability

Accountable Care Organizations and other value-based approaches are putting accountability and efficiency on the forefront of healthcare payments. This is encouraging doctors, hospitals and other healthcare providers to form networks which coordinated patient care and become eligible for bonuses when they deliver efficient care. Providers are making more money when they keep their patients healthy.

The idea of Accountable Care Organizations was first coined in 2006 by Elliot Fisher, the Director of the Dartmouth Institute for Health Policy and Clinical Practices. The concept was included in the federal Patient Protection and Affordable Care Act in 2009. It has been one of the most talked about provisions of the new law.

It is a model for delivering services that offers doctors and hospitals financial incentives to provide good quality care to Medicare beneficiaries while keeping cost down. It has three core principles:

• Provider-led organizations with a strong base of primary care that are collectively accountable for quality and total per capita costs across the full continuum of care for a population of patients.

• Payments linked to quality improvements that also reduce costs.

• Reliable and progressively more sophisticated performance measurement, to improvement and provide confidence that savings are achieved through improvements in care.

This method places a degree of financial responsibility on the providers in hopes of improving care management and limiting unnecessary expenditures while continuing to provide patients freedom to select medical services. Success of ACOs is born out of the ability to incentivize hospitals, physicians, post-acute care facilities and other providers involved in coordinating care. This decreases unnecessary medical care and improve health outcomes.

The program is projected to save Medicare up to $430 million through 2015.

Over the last few years, a number initiatives have been proposed and approved that put more weight on Accountable Care and help hospitals, doctors and providers become ACOs. All of which are designed to make the idea of ACOs more appealing and make the rewards of accountability too much to pass up. It is also having an effect on spending as a whole.

“Over and over again, we have seen that improving how care is delivered to patients is key to reducing the growth in health care spending,” CMS Administrator Donald Berwick, M.D. said in the past. “When we improve the coordination of care between providers, reduce duplication of services, and avoid medical errors, we can get better outcomes for patients at less cost. The Affordable Care Act has given us the tools to achieve these goals.”

The use of accountability in healthcare has made greater strides in the last few years than ever before. With the incentive to take part growing, this idea is showing no signs of slowing down.