4 'Value-Driving Elements' of ACOs Identified

Enhanced access and care coordination are among the cornerstone "value-driving elements" that must be implemented if patient-centered medical homes and accountable care organizations are to succeed.

That's one of several key findings in a sweeping report, Better to Best: Value-Driving Elements of the Patient Centered Medical Home and Accountable Care Organizations  issued Wednesday by the Patient-Centered Primary Care Collaborative. The report was crafted in partnership with The Commonwealth Fund and the Dartmouth Institute for Health Policy and Clinical Practice.

Paul Grundy, MD, president of the Patient-Centered Primary Care Collaborative said the report is most noteworthy for the consensus found among major providers, payers, and consumer groups. "It's the first time there's been such a broad agreement on a set of principles," said Grundy, who is also IBM's Global Director of Healthcare Transformation.

"There's an understanding from providers about what they want to provide and a consensus among buyers that they want to buy what the providers are offering. It is a national consensus across the broadest possible range of players on a journey toward care that's comprehensive, integrated, coordinated and accessible, versus care that's episodic, disintegrated, uncoordinated, inaccessible," he said.

Better to Best provides an action plan for core areas of consensus that were first identified at a one-day collaborative that PCPCC sponsored on Sept. 8, 2010. The collaborative agreed that:

• The goals of PCMHs and ACOs are better care, better health and lower costs.
• Improvement must be considered for lower costs and value to the consumer.
• Ongoing reportable measurements are needed to address these goals.
• Payment systems need to change and several payment models should be tested.
• Learning collaboratives and rapid learning environments are needed to establish an evaluation framework around these issues.

Each point of consensus includes recommendations and action items around policy, research and features to embed in federal demonstration projects. Some require development of new structures for measurement and evaluation, but others build upon existing efforts, such as aligning federal meaningful use standards with health IT requirements associated with medical home recognition and ACO regulations. The group will continue to work together in support of these shared goals.

"This report indicates that key stakeholders are in agreement on the need to promote patient-centered, coordinated care through changes in the way we pay for and deliver care, and development of medical homes and accountable care organizations are mutually reinforcing models for achieving these goals," said Commonwealth Fund President Karen Davis.

Of the four value-driving elements identified, two -- enhanced access and care coordination -- require urgent overhaul to maximize health outcomes at lower costs. The others, HIT and payment reform, are essential tools without which widespread implementation of new care delivery models will not succeed, the report said.

Better to Best lays the groundwork for achieving the Triple Aim: Improve the health of the population; enhance the patient experience of care; and reduce, or at least control, the per capita cost of care, said co-author Elliott S. Fisher, MD, in a statement. Fisher is a leading proponent of the ACO concept. "If we remain true to the agreement made in September and formalized in this document, we have the opportunity to help create an accountable, patient-centered system that not only enhances quality of patient care but controls costs."

The report may be downloaded here.

On Thursday, the Department of Health and Human Services unveiled long-awaited proposed regulations for ACOs.