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The Future of Medicine: Uncertainty and Complexity of Accountable Care

By: :: Published: October 28, 2014

’We will have more information at our fingertips than we ever had in the history of mankind — every day’…Such omniscience has the potential to reverse the perverse incentives — which emphasize treatments rather than results — driving America’s annual health costs past $3 trillion.”

–Excerpt from “Can Patrick Soon-Shiong, The World’s Richest Doctor, Fix Health Care?” – Forbes Magazine, September 29, 2014

Accountable Care Organizations (ACOs) exist at the forefront of change and uncertainty in the U.S. health care environment. ACOs are networks of health care providers — pharmacies, general practitioners, specialists, payers — that communicate and share data with one another to deliver more efficient and affordable patient care. The ultimate goal of coordinated care is to ensure that patients receive the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. In short, ACOs aim to spend health care dollars more wisely.

The U.S. has seen a steep increase in ACOs within the past year. The number of ACOs in the United States now exceeds 600, and approximately 20.5 million lives in the U.S. are covered by coordinated care. With continued government support and considerable growth in the number of organizations becoming ACOs, ACOs have the opportunity to become the dominant model in care delivery.

However, the complexities of specific types of care layer the future of accountable care with uncertainty. For instance, oncology practices have not been keen to switch to the ACO model. The choice of whether to actively treat or simply monitor a cancer’s progress may be cost-effective for the ACO but may appear as an indicator that the organization is willfully withholding care in order to save money. Some health plan executives highlight the broad base of uncertainties in cancer care that would complicate the ACO payment model. As oncology operations officer Ronald Barkley, MS, JD stated in the Journal of Oncology Practice, “I don’t think there has been a really consistent definition of cancer care…without that definition it’s hard to dig financially into any organization’s operations to determine true costs.”

The future of ACOs across all health care providers remains very uncertain and complex. In December 2012, payer Florida Blue unveiled a clinical integration agreement — a form of a private ACO — with Moffitt Cancer Center in Tampa. The venture seeks to incorporate a value-based reimbursement system while improving patient care by sharing clinical and administrative claims data. ACOs like this in oncology and other forms of secondary care remain in the experimental phase. However, the success of ACOs in primary care — as demonstrated by Medicare savings of $380 million in the first year of new care organizations’ operations — encourages trials across the most expensive areas of health care. Success of pioneer ACOs in oncology may open the floodgates for the adoption of ACOs across specialty care.

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