More than 30 years later, Fisher believes the best way to improve healthcare is through accurate information and statistics. Data gathering and analysis is the key to creating successful ACOs, a cornerstone of the new healthcare reform law. Fisher has outlined four goals that need to be met for ACOs to be truly accountable: Clearly defined aims, detailed performance measurement, true integration, and financial incentives aligned with the aims.
A lack in clarity on the aims of healthcare and poor information are major underlying problems in the current delivery system that is contributing to inefficiency and uneven quality of care, Fisher says.
"The notion of accountable care is being accountable in communities," he says. "We have insufficient data on performance that leaves us unsure about how to improve either [efficiency or quality] because we really have not measured performance adequately. We need meaningful measures of performance that are used to support clinicians in their efforts to improve and reassure the public that they're getting better care."
The current system also has fundamentally uncoordinated care, which leads to a skewed rewards structure.
"Each physician and hospital performance is measured on individual attributes and there's the payment system rewarding that fragmentation," he says. "There's little integration that helps patients navigate their way through a complex healthcare system. One of the principles of an ACO is creating organizations that support integration for patients. The system we have now simply rewards more care, but we need to align our system so it rewards better care."
The journey to create thriving ACOs will likely take 10 years, Fisher says, as organizations learn what works and what doesn't. He envisions himself working to perfect accountable care for at least the next five years.
"What I'm enjoying doing now is trying to help the major stakeholders in the U.S. healthcare system, from consumer groups to payers to the federal government, figure out how this notion succeeds," he says. "That's collaborative work; it's figuring out how we can get to the measurements that we want. What I hope to create is a learning system that gets us good information about the performance of ACOs and why they succeed and why some were less successful. That allows us to disseminate that knowledge to others so we quickly identify organizational missteps and are able to correct them."