Sustainability of Accountable Care

Organizations

Bruce Bodaken, MAVisiting Scholar, Brookings Institution; Lecturer, School of Public Health, University of California, Berkeley; Former Chairman and CEO, Blue Shield of California

Spring 2015 Berkeley ACO WorkshopMay 8th, 2015

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Isn’t it too early to focus on ACO sustainability?

Many ACOs have a 3-4 year track record

Early lessons from mature models are important for assessing ACO achievement of the Triple Aim

Sustainability of ACOs

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Challenges to Sustainability

Moving from low hanging fruit to tree tops to ??

Living in the world of FFS and VBP even after 4 years

Actionable, real time data for patient care that can be shared remains illusive (after millions of dollars invested)

Purchasers are impatient if initial % savings aren't repeated annually

Limited Resources, Unlimited Expectations

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Facing the Challenges

Developing the appropriate policy framework - the investment horizon distinction between start up and ongoing costs

Federal IT policy should create meaningful financial incentives to fund initial and ongoing investments

Mature business models should distinguish between short term and longer term savings opportunities

Limited Resources, Unlimited Expectations

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Aspirational Attributes of Mature ACOs

Strength in leadership and governance capable of weathering failures

True clinical integration that includes essential data and human elements

Integrated technology designed for long term results

Business model alignment among partners that explicitly resolves questions of ongoing investment

Limited Resources, Unlimited Expectations

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Incarnation of Attributes

Leadership and Governance

Partner senior executives dedicated to a primary care based model that over time delivers ever increasing quality, financial performance improvement, and consistently superior patient experience

Transparent and constant communication

Limited Resources, Unlimited Expectations

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Incarnation of Attributes

Evolved Technology

Modern flexible IT systems enabling and tracking the improved health of a defined population

Predictive analytics, risk stratification of the identified population

EHRs designed to be interoperable with other care systems to create a dynamic picture of the patient

Privacy protection for secure messaging, video communication, and other forms of engaging patients in their own care

Limited Resources, Unlimited Expectations

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Is ACO Success at Risk?

All experiments in care transformation are imperfect in their origin

Success must be properly understood in a policy, political, and institutional context

Declaring success too early could cloud the record

No other change except the creation of HMOs has had such focus and interest

The setting, timing, and support bodes well

Limited Resources, Unlimited Expectations