Q&A: Aetna's Charles Kennedy on Developing ACOs

HLM: Any surprises?
Kennedy: The importance of governmental payment innovation in helping us create the type of financial returns necessary for delivery systems to embrace ACOs was a surprise. It's possible to do ACOs in a commercial environment, but it really sings when you can get Medicare aligned because there's so much waste and inefficiency in Medicare.

I thought there would be a certain amount of reticence on the part of delivery systems to embrace a collaborative relationship with a health plan. It's typically us versus them at the negotiating table.

But once you demonstrate that your business model is a win-win, I was amazed how quickly we shifted from being an opponent to a trusted friend. That's probably the most gratifying success we've had.

The challenges associated with adapting clinical health information technology to ACO operations surprised us. People seem to think if they buy an EMR or they have a health information exchange in place, then they are in great shape for ACO operations.

The challenge has been to get the technology adapted so it supports the contract variables for success. Most of the stuff that's out there isn't designed that way so that was more of a challenge.

I was surprised at how much help many of the delivery systems need. Some have technology that can't help them with an ACO, and they don't have a clear understanding of what they need to do to be successful at this.

Technology is a fundamental problem. The EMRs of today grew up before there was a notion of accountable care. If you're operating in a fee-for-service world, you need better documentation to maximize reimbursement. The challenge with an ACO is to turn that information into something that can be sent back to doctors to help them make decision consistent with evidence-based medicine.