Beyond PCMH: Is your practice an "accountable care organization"?

The patient-centered medical home model, which has been in the spotlight over the last few years, may soon have to share the stage with a new model: the "accountable care organization."

What's an accountable care organization? According to a recent report from Harold Miller, executive director of the Center for Health Care Quality and Payment Reform, an accountable care organization is "a health care provider or group of providers that accepts accountability for the total cost of care received by a population."

What does a practice need in order to act as an accountable care organization? Miller identifies eight elements:

1. Complete and timely information (including cost information) about your patients and the services they are receiving. Miller notes that most practices will need "significant assistance" from payers in order to obtain this information.
2. Technology and skills for population management and coordination of care, such as using clinical guidelines and monitoring compliance with them, analyzing data on resource use and utilizing a patient registry.
3. Adequate resources for patient education and self-management support.
4. A culture of teamwork among the staff of the practice.
5. Coordinated relationships with specialists and other providers.
6. The ability to measure and report on the quality of care.
7. Infrastructure and skills for management of financial risk.
8. A commitment by the organization’s leadership to improve value and create operational accountability.
   
   

How does an accountable care organization differ from a patient-centered medical home? According to Miller, "Most initiatives today to help primary care practices become Medical Homes do not require that the primary care practice accept any accountability for the total costs of care for their patients or for population-level quality outcomes. Even though many of the enhanced resources and tools being developed and used by Medical Homes, such as electronic health records, patient registries, patient education on chronic disease management, and more responsive scheduling, could help improve quality and reduce total costs, there is no guarantee that they will do so unless the primary care practice actually focuses on improving those outcomes as an explicit goal and uses the medical home tools to achieve the goal. Indeed, the Congressional Budget Office, in evaluating various health delivery reform options, estimated that paying for Medical Homes for chronically ill beneficiaries in Medicare would increase spending by $5.6 billion, rather than reduce costs."

Miller continues, "This implies that while becoming a Medical Home could help a primary care practice become an Accountable Care Organization, it is not sufficient. Conversely, in order to function effectively as an Accountable Care Organization, it may not be necessary for a primary care practice to meet all of the detailed standards that organizations such as the National Committee for Quality Assurance (NCQA) require of primary care practices in order to be formally designated as a 'Patient-Centered Medical Home.' Indeed, detailed accreditation standards are being used in medical home programs partly because payers are concerned about whether making higher payments to primary care practices to enable them to serve as medical homes will actually result in improved outcomes for patients and lower costs for payers. Since there is not strong evidence that all of the structural and process standards established for medical homes are necessary for improved patient outcomes and some may be difficult or expensive for practices to achieve, and because some practices that would not meet these standards have been successful in proactively managing and coordinating their patients’ care, a primary care practice should not be precluded from serving as an Accountable Care Organization simply because it has not met accreditation standards as a Medical Home."

Posted at 12:37PM Oct 16, 2009 by Brandi White  |  Comments[0]