Are Accountable Care Organizations doing enough for population health?

Accountable care organizations' responsibility for population health should be better defined, two Weill Cornell Medical College researchers argue in today's Journal of the American Medical Association. 

"Talking about ACOs as if they are focusing on improving population health--as opposed to improving medical care for their populations of patients--leads to a lack of clarity about what ACOs are doing about population health and may divert attention away from social and public health services and from socioeconomic factors critical to health," the authors write in the JAMA article.

The formulation of effective healthcare and social-service policy is dependent on clearly defining population health as it relates to ACOs, Weill Cornell says in an announcement about the article.

Based on wording in the Affordable Care Act, the phrase "population health" implies ACOs address the health of Medicare beneficiaries in a provider organization, not everyone living in the organization's geographic area, lead author Douglas Noble, M.D., said. "It falls far short of working to improve the health of the population in a geographic area."

"When population health is clearly defined, it becomes possible to think more specifically about what needs to be done to improve it, whether and how ACOs can help, the types of organizations with which ACOs will need to cooperate and the incentives that ACOs--and other organizations--will need to improve the health of the population in their geographic area," senior author Lawrence P. Casolino says in the Weill Cornell announcement.

The authors said ACOs' role in developing "accountable health communities" can only be determined if the phrase "population health" is used clearly to define geographical populations, not the organization's patient population.

Among initiatives to improve population health, the Centers for Medicare & Medicaid Services launched a patient-centered medical neighborhood earlier this year across 15 systems in several states to try to cut healthcare costs by nearly $50 million and improve patient population health by 15 percent.

Meanwhile, three healthcare experts recently argued in the Wall Street Journal that ACOs are based on flawed assumptions about how doctors and patients behave and make decisions about healthcare spending.

To learn more:
- here's the JAMA article (subscription required for full access)
- read the Weill Cornell announcement