Look What’s Talking Now

Aug. 16, 2013
For cynics and critics, nine Pioneer ACOs dropping out of the program spells doom for the entire accountable care movement. While I understand that sentiment to some degree, I think people are willing to write their obituary far too soon

I’m used to deflecting negativity. It’s part of where I come from and how I am.

That’s not to say I never have moments of doubt and skepticism (after all, I do work in the field of journalism). Quite the opposite; I can be extremely pessimistic and sarcastic. But a lot of times, if I believe in something, I’m going to stick with it until the bitter end.

Case in point, one of my favorite shows in the past year, “Happy Endings,” was not what you’d call a ratings hit. It barely got by for three seasons on ABC, despite being a whip-smart comedy with a talented group of actors. When I heard it was in danger of cancellation, I refused to believe ABC would actually pull the plug on a show with a strong cult following.

Unfortunately, I was wrong. But even after ABC took it off its schedule, I thought maybe some other network would pick it up. Wrong again. No one bit. And even though it’s dead and gone, I’m still holding out hope that it can stage an “Arrested Development”-style comeback in the coming years. See what I mean?

There has been some talk lately whether or not the accountable care organization (ACO) movement is viable for the long-term. It comes on the heels of the announcement in late July that nine Pioneer ACOs dropped out of the program and only 13 of 32 in the program reported decreased costs.

Clearly, this was a disappointment. You can’t mask that in any way, shape, or form. It was the first year of the program and the fact is that some have already dropped out and only 40 percent of the participants had earned bonuses. Some, like Jeff Goldsmith from Health Affairs, sees this as an ill-fated start for the program.

If the most sophisticated provider-based managed care enterprises cannot master this program, neither will most of the nation’s community hospitals, even with the help of an avid corps of consultants and policy cheerleaders. – Jeff Goldsmith

Ouch. Goldsmith goes on to write that based on what we’ve seen thus far, it’s unlikely that ACOs are going to be viable as a total replacement for fee-for-service Medicare. If I had to take a wild guess, this kind of cynicism is not unusual in the industry right about now.

Still, I think there is room for positivity when it comes to ACOs. It’s not that I believe in them, but I think people are willing to write their obituary far too soon. There are plenty of ACO success stories out there, proof that this can work. Take the Duluth, Minn.-based Essentia Health, a member of the Centers for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program and a National Committee for Quality Assurance (NCQA) approved ACO.

 I read an enlightening article over at KaiserHealthNews about how Essentia is using patient monitoring technology in the form of a talking, interactive weight scale to track its patient’s data remotely. The weight scale, which literally talks to patients, is used for those with heart disease, and it has helped Essentia prevent problems and lower its readmission rate to no more than 2 percent.

The problem with the ACOs that dropped out isn’t with the model. It’s that those providers weren’t ready. So says Michael Nugent, managing director of the healthcare practice at Navigant, a Chicago-based consulting firm, in a great Q&A with our own Rajiv Leventhal.

These organizations did not have the information spreadsheets, analytics, or horsepower to prioritize the cost savings opportunities. We have learned that a lot of those opportunities were in the post-acute space, and some organizations did not have the firepower to identify that. – Michael Nugent

Essentia isn’t the only one who showed what can happen when you are ready. Look at what has been done at Montefiore Medical Center in the Bronx and the Partners Healthcare ACO in Boston. Both have achieved levels of success at the ACO level, from a cost and quality savings perspective.

Even those that moved on from the Pioneer ACO program aren’t giving up yet. In the September issue of Healthcare Informatics, Texas Health Resources’CIO Ed Marx said even though they left the Pioneer ACO program, the organization is still intensely focused on accountable care. They are looking into other arrangements because they know how important this is to the future of healthcare. There is a lot to be said for Marx’s attitude and the significance that ACOs hold for provider organizations.

So, to those cynics, do not yet toast to a government-sponsored failure. Let’s let the weight scale do the talking and see how this all plays out!

As always, I want to hear your thoughts. Feel free to leave comments below or respond to me on Twitter by following me at @HCI_GPerna.

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