McClellan: ACOs difficult but possible

"ACOs are not made up of a few steps, but fundamental change...in organizations 'walking the walk' in improving care and lowering costs," said Director of the Engelberg Center for Health Care Reform Mark McClellan, MD, PhD, at today's Second National Accountable Care Organization Summit in Washington, D.C.

Acknowledging that those key ACO objectives of improved patient-centered care and cost containment don't happen overnight, McClellan set the stage for this week's ACO summit by recognizing the challenges associated with creating and implementing ACOs, while remaining confident that the U.S. could move toward sustainable spending.

Last week, the Congressional Budget Office released it gross domestic product (GDP) report, which concluded that healthcare spending would more than double by the next decade and make up 9.4 percent of the GDP by 2035.

"The need for accountable care has never been more urgent," said McClellan, citing the budget report.

McClellan stressed that ACOs would increasingly come into play in containing those costs, and the key to ACOs are secured commitment from organizations, both clinically and financially.

Since March when the Centers for Medicare & Medicaid (CMS) released the proposed rules for ACOs, more than 1,200 comments have flooded CMS, which are expected to influence the final rule, when released.

One of the barriers to ACOs, organizations and providers have criticized, are the associated start-up costs of implementing such an overhaul of the system for Medicare payments away from fee-for-volume. In addition, ACOs present legal challenges in which antitrust laws may prevent market dominance that could be an indirect result of organizational and provider collaboration. In addition, there are challenges in patient notification of ACO participation.

The Brookings Institute and the Dartmouth Institute for Health Policy and Clinical Practice make the following recommendations for ACO implementation:
- Reduce the administrative burdens and implementation costs
- Optimize data sharing, patient assignment, patient notification, and benchmarking
- Build sustainable pathways to quality improvement
- Reduce uncertainty by providing predictive data
- Better leverage and align between private and public initiatives

"There's no fully written playbook," said McClellan, but people are already doing it. For example, there are 30 organizations who are participating in the ACO Pioneer Model program for advanced organizations and providers who will most likely serve as the role models for future ACOs. "That incremental progress is what leads to fundamental change," he said.

When it comes to improving care and cutting costs, ACOs are not going to be a solution to all of these problems, but neither is anything else we have out there currently, said McClellan. "We're living through this process," he said.

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