Part 1- The Goal of Accountable Care

Accountable care is a new term (really only around since 2006 or so) that is now common in healthcare policy circles. It’s a funny term since most laypeople wonder what distinguishes an accountable healthcare system from an “unaccountable” one. After all, for most patients, doctors and health systems are (and always have been) “accountable”– accountable for maintaining health, for managing illness etc. Why would you ever get care at a place that lacks the most basic requisite: a sense of responsibility for the service that’s delivered to its customers?

 

 In this section, let me provide my own take on what “accountable care” means, and how we got here as a nation.

 

At its most basic level, an accountable healthcare organization is one where the health payer (usually an insurance company, or the federal government) and a health delivery system agree to set reimbursement according to the extent that cost-effective, high-quality care (for an enrolled population of patients) is actually delivered.  It is a move from the traditional “fee-for-service” world where doing things rather than generating results is rewarded.

We call a results-oriented system accountable because in exchange for taking in money, accountable healthcare providers are expected to deliver high quality, accessible care. The Institute of Medicine’s defines high-quality care as:IOM

But, more than this, accountable organizations need to deliver cost effective care.  Cost has become as big a problem as the quality of care delivered– which we will discuss in the next section.

The point to conclude with is that health reform efforts, and the move toward accountable care, are designed to improve the value of care delivery (which is basically a ratio of outcomes/ cost).

First-  lets discuss background in Part 2 

 

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