This week, I had the opportunity to participate in a community event put on by the Health Enterprise Network of Louisville. One of the featured speakers was Dr. Bruce Harmony, MD, FACP, former Chief Medical Officer at Geisinger Medical Center in Danville, PA. Dr. Harmony is now the Managing Partner of Geisinger Consulting Services.
Growing up in central Pennsylvania, and spending many hours delivering patients to Geisinger as a volunteer fire fighter and ambulance driver during college, I am very familiar with the fabulous work that has been done at Geisinger over the last five decades. It is clearly one of the premier health care systems in the country. It is also one of the models for the Accountable Care Organizations defined in section 302 of the Patient Protection and Affordable Care Act of 2010.
According to the panel at the Health Enterprise Network event, an Accountable Care Organization (ACO) is “an integrated provider system that is accountable for a patient population.”
Unlike the concept of capitation that was promoted in the mid 1990’s, ACOs will receive payment on a fee for service basis, and will be eligible for additional payments if they achieve cost savings and meet performance standards for quality.
According to Dr. Harmony, the concept of ACOs has been around for 15 years, but it has only been in the last 5 years that specific language and descriptions have more clearly defined them. As one panelist put it, “A ACO is like a Unicorn. It’s a fascinating animal, but no one has ever seen one.”
What will Home Health Care’s Role be in the ACO?
In listening to the expert panel on ACOs, and in reading the elements of the Affordable Care Act, it is pretty clear that there will be an important role for home health care. We have specialized expertise and capabilities to aid the ACO in
o Care Transitions – moving patients from hospital to home
o Care Coordination – linking together various providers
o Chronic Diseases Management – patients with five or more chronic conditions consume huge amounts of health care resources
o Wellness and Prevention – reducing cost by improving health and avoiding disease
It’s clear that we will have an important role to play in the success of ACOs. There are two looming questions:
- How will ACOs pick their home health care partners?
- Will home health care partners share in the savings, or will we be treated as sub-contractors to the ACO?
The answers to these questions lie in the value that we bring to the ACO and it’s principles. It pretty clear that successful ACOs will be physician driven, and will partner with hospitals and other acute and post-acute providers. Will the leaders of the ACO see home health care as bringing significant value to the equation?
Ed Haislmaier, Senior Fellow at the Center for Health Policy Studies at the Heritage Foundation focused on the rise on chronic conditions due to pollution, stress, and obesity. He said that 20 million people with five or more chronic conditions represent 6% of the population but use 30% of the health care resources.
John Holahan, PhD, Director of the Health Policy Research Center at the Urban Institute was another panelist at the Health Enterprise Network event. He said, “Price is what you pay. Benefit is what you get. Value is the relationship between the two.”
The group generally agreed that health care in America is the most expensive in the world, and the benefits are uneven depending on geography and social economic status. In essence they said, “We’re spending to much for what we get, or we’re getting too little for what we spend.” We need to have a better value proposition.
I think we can all agree that home health care can add to that value proposition by providing higher quality health outcomes at lower cost to the consumer and the payer. How, then, do we convince the principles of ACOs that we can make a difference for them in cost savings and quality performance measures?