Accountable Care is a payment and delivery model that relates quality and cost. It is conceptually very similar to the HMO models of the 1970s. Interestingly, the same players have rejoined the game.
Tallies are made on three items:
At first reading, these are undeniable truths, but further thought brings untenable falsehoods.
They are significant, and both the process and the products arehighly questionable.
- Where are the Carl Bernstein’s, Jacob Riis’s, and Robin Cook’s of the world? Why does the Affordable Care Act (Obamacare) feel as complicated as the disease of the system itself?
- Why have thousands of lobbyists participated in a process that leaves the individual citizen/patient overwhelmed and under-informed.
- Why must discussion be brought down to sound bites?
Instead of sound bites, let’s focus the fundamentals of health care. Let’s focus on patients and those who care for them. When it comes to paying and payors, it all becomes too impersonal, too murky, and frankly, too suspicious. Maybe the healthcare system has become so complex, and so inter-twinned, and so self-interested, than no one Bernstein, Riis or Cook can take on the investigation that is needed. Still, fortunately, questions are being raised.
All of that said, and all of that needed, we each can do our part. Our warning is about quality. Not quality itself, but about defining quality. Our concern is that to measure quality one needs numbers. To get numbers one needs definitions. To get definitions on needs language. To get language one needs ideas. And that is where the problem lies. Ideas can be new or old; accepted or controversial; hackneyed or original; common or cultural.
It is naive to think that judging data will “incentivize” quality. What is measured, indeed, is what is changed, but when an institution (government or corporate) measures things, its citizens and employees fill out whatever form is offered to get the reward, and most often do not accept the penalty to reach a higher good. Can complete, comprehensive empathetic care be measured by ICD-9 or ICD-10?
For instance, is "incentivize hospitals, physicians, post-acute care facilities, and other providers involved to form linkages and facilitate coordination of care delivery" really collaboration? Who benefits? Is the patient or the ACO at risk? Is doing nothing good or bad? Does compromise of treatment, because of a compromised patient, acceptable.
This is not a new debate. Thus the reminder is that the patient must be the final beneficiary of quality improvement. It is the patient who sits before you, places trust in you, and ultimately lives or dies because of you. True quality is getting the best data available (yes even from an EMR/EHR) and then doing your very best, as an individual with an individual to get he best answer. This requires true medical collaboration on behalf of the patient. Collaboration requires exchanging data, experience and judgment. It is an extra effort. It takes work—in the past telephone tag, long and inaccurate descriptions, and long meaningless “reports and consults” from “incentivized” consultants were bad enough. Not to be out done, primary care providers now send a 12 page EMR referral with every single checkbox filled in. Nobody thinks, they just generate data, devoid of interpretation, and without understanding.
Now, iClickCare makes it much better and easier. We must not jump over the bar that is given to us, but instead consider what is needed for the patient in front of us, and raise the bar for ourselves. iClickCare empowers the part of ACOs that matter for the patient -- patient centered collaboration.
(1) McClellan, Mark, et al. A National Strategy to put Accountable Care into Practice. Health Affairs. 29(5). 2010. 982-990.