The Patient Protection and Affordable Care Act represents one of the most ambitious health care reform initiatives this country has experienced. One of the law’s provisions calls for the creation of Accountable Care Organizations (ACOs), systems that aim to provide improved care coordination and save money through better health management and preventative strategies.
The ACO concept originated in March 2011 when the Department of Health and Human Services (HHS) proposed a set of rules that would provide complete and coordinated care for Medicare recipients. Under a collaborative system, providers, practices and hospitals work together to treat a patient across several care settings, from emergency and inpatient services to ambulatory and specialty care, covering both physical and behavioral health needs. In addition, the ACO focuses on prevention and management of chronic disease as part of the overall health care continuum.
A report from Oliver Wyman, a global marketing consulting firm that specializes in several fields including health and life sciences, indicates that 2.4 million Medicare patients and as many as 29 million non-Medicare patients are already receiving care through an ACO.
In January, the Centers for Medicare and Medicaid (CMS) reported that more than 250 ACOs have been established since the passage of The Affordable Care Act.
Involved in health reform since 2002, Paul Block, Ph.D., director of Psychological Centers in R.I., has worked within a patient centered medical home (PCMH) model, which should, but often does not, include behavioral health care services. He believes that physical and mental health are related and that managing both is critical to keeping health care costs in line and delivering effective services. However, he is not sure that ACOs offer the best solution.
According to Block, ACOs feature two dimensions: a clinical side, which is, or can be, extraordinarily successful and the financial aspect, which can limit the clinical practice. “The biggest stumbling blocks to the success of ACOs are management, responsibility and coordination. The providers have to figure out how to manage services to benefit from the different contract terms,” says Block. “If behavioral health services are used wisely, it can save the ACO money and increase outcomes, but figuring out how to use the dollars and time is the problem. If the insurers don’t have the time or in-house expertise – or contract with behavioral health “carve out” managers who can adequately manage the impact of behavioral health concerns and services on medical care – then how do we expect the medical provider groups to be able to do it?”
Although certain aspects of the prototype are commendable, Block questions the reality of successful implementation. “I like the model in some ways. The idea that we can affect decision-making time and offer our expertise is a positive, but we need to also take a financial risk and we may not have the size, funds or expertise to take that risk or to manage services effectively across all levels of care,” he says.
By Phyllis Hanlon