Collectively, we are trying to bend an iron-stiff cost curve by moving from a system of hospital dominance to more cooperation with physicians. We’re replacing costly and inefficient fragmented care with accountable care, where a coordinator is incentivized to drive efficiencies for the patient. Bringing more people under the tent of insurance coverage is critical to this process.
Those are all good things, but the process of bringing those goals to fruition can be a headache. Accountable care organizations (ACOs) are emerging at an extremely fast pace throughout the nation. The country’s ACO tally has jumped to 606, more than four times the ACOs listed in 2011, when there were 138. And Mercer’s National Survey of Employer-Sponsored Health Plans 2014 found the use of ACOs growing rapidly among the nation’s largest employers — from 25% in 2013 to 33% in 2014.
Promises to improve health care quality and implement efficiencies to keep costs at bay have spurred ACOs’ stellar growth. You’d be hard pressed to find any health care provider not considering an ACO future.
According to the Centers for Medicare & Medicaid Services (CMS), an ACO is "an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it." Quite a broad definition.
So how can you spot the real ACO versus the pretender?
One quick way to spot a real ACO could be the use of accreditations like the National Committee for Quality Assurance. In the absence of a greater level of accreditation for ACOs we must look at the basic characteristics that support the Triple Aim: Better patient experience, better health, and lower per capita cost.
The characteristics or processes that support a top-tier ACO are:
Until accreditation and additional publicly available data mature, it will be difficult to tell the pretenders from the real ACOs. In the absence of better measures, remember the basic tenants of the triple aim and the ACOs’ ability to integrate data, improve care, reform payments, and provide quality health care leadership.
Eric Bassett is a senior partner and leader of Mercer’s Health and Benefits business in the Central market, based in Dallas.