Accountable healthcare: the pros and cons

There is growing interest in the potential for accountable healthcare to contain costs while promoting patient-centered, affordable care. As mentioned earlier in this section, the health care industry has seen the recent proliferation of ACOs throughout the country. More than half of the U.S. population now lives in areas served by ACOs, with at least 28% of U.S. patients living in in areas served by two or more ACOs. In total, ACOs now cover 37 million to 43 million Medicare and non-Medicare patients.¹

Despite this rapid growth, especially among physician-led organizations, accountable healthcare is still in the early stages of development. There are important, unanswered questions about how to measure quality in an ACO, how to calculate financial rewards for participating providers, and even whether the model has long-term viability.

Here are some challenges for organizations that may be considering accountable healthcare:

• Setting up an accountable healthcare organization like an ACO means balancing risk with the interests of the individuals and organizations involved.

• Organizations must adopt health information technology (HIT) to coordinate and manage large amounts of data, both within and outside the organization, to coordinate care, perform quality reporting and fulfill accountable healthcare objectives.

• Getting buy-in from patients will require education about the potential benefits of accountable healthcare.

Despite these challenges, there are potential benefits to forming or participating in an ACO:

Potential benefits for hospitals:

• Better and quantifiable clinical outcomes

• Physician loyalty

• Decreased costs

• Increased efficiency

• Improved relationships with community healthcare partners

• Stronger patient satisfaction

Potential benefits to physicians:

• Meaningful participation in ACO leadership

• Improved workflow

• Better access to clinical information

• More information and tools available to manage cases across multiple visits and multiple providers

• Improved use of evidence-based medicine through disease management protocols and clinical decision support

Potential benefits to patients:

• Coordinated care team with a single point of access

• Better health outcomes and satisfaction with care

• Elimination of out-of-pocket charges for certain preventive care and screening

• Availability of full medical history by all members of the care team

• Fewer medical tests and medical history paperwork 

• Better control over and involvement in health care

^{1Oliver Wyman. Available at: http://www.oliverwyman.com/media/ACO_press_release(2).pdf.}