For years, the U.S. health care system has been called broken. Health care costs continue to spiral upward, outpacing inflation, and the quality of care has been lacking, even among primary care physicians. Given these issues, health care consumers are struggling to get the care they need at an affordable rate.
To counter this broken system, the Obama administration passed the controversial Patient Protection and Affordable Care Act in 2010, and a portion of that bill focuses on integrating accountable care organizations, which are beginning to garner more attention for how they can possibly change the market.
Sparking payment reform
There also is a greater focus on prevention and wellness programs with ACOs, and this leads to a completely different kind of care, compared to traditional health care models, says Jill Hummel, vice president of payment innovation at WellPoint in Indianapolis. ACOs follow an integrated system that requires the health of the population be managed through accountability efforts, changing how health care is delivered.
With a highly fragmented health care system, patient satisfaction also suffers, Sherry says. When paired with affordability and a high quality of care, an ACO program achieves what Sherry calls the “triple aim.” As all three elements are achieved, Sherry has found ACOs have experienced success, especially regarding medical costs and gap closures.
“We absolutely are studying the impact of these better collaborations and sharing information and integration from a clinical perspective, and where we’re seeing very promising results are on the cost and quality sides,” Sherry says. “We have several studies that are showing specific collaborative accountable care, figures like 7 percent better medical costs, compared to the peer group in the market with these collaborations. We’re seeing other collaborations demonstrate 10 percent improvement in their ability to close gaps in care for things like diabetics taking their medication and folks having mammograms, those types of gaps in care.”