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Accountable care at the frontlines of a health system

October 4, 2019

In a time of uncertainty about the future of healthcare in the United States, at least two issues are clear. First, the current system is flawed—at times delivering both too much and too little care that is often fragmented, poorly communicated, and expensive. Second, the incentives in still-pervasive fee-for-service payment models are the basis for many of these problems. The current policy antidote, consisting of alternative payment models such as accountable care organizations (ACOs), builds on the failed managed care experiment of the 1990s, again relying on a budget for a defined population of patients but this time with checks on quality, unrestricted patient choice, and attenuated financial risk. Although early studies of the model show only modest success thus far, ACOs now cover more than 32 million individuals in the United States through commercial and public contracts, and the federal government has indicated it will continue to emphasize this approach.

For many health systems, the ACO model provides a catalyst for much-desired improvements, both through well-established mechanisms and more experimental approaches that can now be explored. Strategies such as care coordination for high-risk patients may help health systems succeed in ACO contracts but, more importantly, they represent better patient care. These strategies, collectively known as population health management, usually succeed or fail on the frontlines of care delivery. So the key question is how systems translate well-intentioned policies into actions that are meaningful for the clinicians in these settings. This Viewpoint examines tensions between the aspirations and realities of accountable care and how health system leaders might ease the transition from volume to value.

Read the entire article: JAMA

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