A comment by Naveen in my post about the Health IT and EHR Bubble, caused me to stop and think:
HIE will eventually become the new necessity in the light of the development of regional ‘community’ systems of care (aka ACOs) – in the same way that EHR’s enable a system to talk, they inhibit neighbors from talking.
I had to think this over a little bit to understand that final part about inhibiting neighbors to talk. If I understand him correctly, the challenge is that if I’m in ACO A and my neighbor is in ACO B, then I actually don’t want to communicate with my neighbor.
This is a bit troubling when you think about the value that can be gleaned from exchanging healthcare data. If we aren’t careful as we build ACOs we might be building in more perverse incentives for doctors to not want to do the right thing. This is a huge problem in healthcare now. We don’t need to make it any worse.
Accountable Care Organizations are similar to the Euro – nothing more than a new structure, committees and bureaucrats that will deliver value only if behavior changes.
To have accountability – you don’t need an entirely new infrastructure. In fact, you may get the opposite if patients are allowed to freely choice and move around.
Healthcare needs a different type of accountability. Unfortunately, this is challenging if you have to practice defense medicine.
ACO A & ACO B will be competing based on quality and transparency in the public domain. This will be a race to the best care. The old paradigm will be history in ten years. Time to move and abandon the horse and buggy.
The key to thinking about accountable care is to focus on the 3 success factors: trust, risk-taking and evidence. All are essential especially in the context of diminishing revenues. As you look for the pioneers you quickly realize they have been pursuing quality in the form of evidence for years as well as piloting reimbursement paths to gain experience.
We have come to the tipping point and those who are fighting the accountable care pathway will find themselves in considerable financial distress within 3-5 years. It’s time for leaders to step up rather than stand on the sideline. BTW, physicians must be in the leadership vanguard with authority and influence and not in positions of window dressing.