As the landscape for accountable care organizations (ACOs) takes shape, Health Quality Advisors and the National Partnership for Women & Families today issued a white paper describing how best to implement a cornerstone of this new health care model: patient-centeredness. The paper, Building Patient-Centeredness in the Real World: The Engaged Patient and the Accountable Care Organization, is a collaboration between the two organizations, produced with support from Aetna.
"Genuine patient-centeredness is more than mints-on-the-pillow at the hospital, a hearty handshake from the doctor and a couple of reminder emails to take your medications after you get home," said white paper author Michael L. Millenson, president of Highland Park, IL-based Health Quality Advisors and a nationally recognized expert on improving the quality of health care in the United States. "It’s important for policymakers and providers alike to recognize that deeply engaging patients in multiple ways is critical to ACO success."
"ACOs are a complex undertaking, and it’s clear that they can’t deliver better care at a lower cost without engaging patients fully, from governance and policy, to quality improvement, to patient-clinician interactions," added Christine Bechtel, vice president of the National Partnership. "We want to see ACOs that enhance the quality of families’ lives and deliver the caliber of care that all patients deserve. Fortunately, the Affordable Care Act recognizes that rethinking the relationship between patients and professional caregivers is key to making that happen."
The white paper examines how "consumerism" in medicine is actually composed of separate but intertwined ethical, economic and clinical concepts and how ACOs provide a structure for turning those concepts into a functioning reality. It reviews the evidence that patient-centeredness can improve care and costs, and it looks ahead to challenges related to making patient-centeredness an integral part of care. At the same time, it provides examples of five organizations that have successfully engaged patients in ways that have improved the patient experience of care, clinical measures and cost-effectiveness.
An ACO agrees to be responsible for all the care needs of a group of patients inside and outside the hospital and to be paid based on its success in achieving specific targets related to those patients’ health outcomes, satisfaction and costs. Unlike the approach in fee-for-service medicine, clinicians and the hospital have a financial incentive to work as a team to keep patients healthy and to better coordinate care.
The Medicare Shared Savings Program of the Centers for Medicare & Medicaid Services (CMS) launched in April 2012 with 27 ACOs in 18 states. Earlier, CMS chose 32 more organizationally advanced groups to be part of the Pioneer ACO demonstration project. In July, CMS is expected to announce the next wave of ACOs.
Together, these ACOs and another six ACO-like organizations in a different Medicare demonstration project serve more than 1.1 million Medicare beneficiaries. Another 150 groups have applied for a July 1 launch date. CMS projects that several million Medicare beneficiaries will receive services from up to 270 ACOs over the next three years.
The paper notes that it has taken a full century for the patient’s perspective to go from being routinely ignored to being hailed as a pillar of an ideal health care system, but concludes that the path to building a patient-centered health system in the real world is clearly marked. "Providers and policymakers should know that deep and lasting change is possible today," Millenson said, "and ACOs are well-positioned to spearhead that change."
The full report is available at www.nationalpartnership.org/ACO.
The National Partnership for Women & Families is a nonprofit, nonpartisan advocacy group dedicated to promoting fairness in the workplace, access to quality health care and policies that help women and men meet the dual demands of work and family. More information is available at www.NationalPartnership.org.