About those Accountable Care Organizations

As North Carolina lawmakers debate the concept of relying on Accountable Care Organizations to help manage Medicaid reform, they won’t find much support for the idea in the latest issue of Forbes magazine. Jonathan Bush, CEO of Athenahalth, shares his concerns about ACOs in a guest “Thought Leaders” column.

It is axiomatic in the technology sector that disruptors fuel the breakneck pace of innovation. These are thinkers and dreamers who look at the established players and the status quo and see, clear as day, that there is a better way. They see a better way of programming thermostats, controlling light switches, listening to music and doing a million other daily tasks, and our lives are infinitely better for it.

For reasons that keep me up at night and make me want to bang my head against a wall, it seems similarly obvious that disruption in health care might as well not exist. Sure, our experiences with health care are horrible expressions of our humanity and it seems that there must be a better way, but the message from all sides is loud and clear: Disruptors need not apply.

The Affordable Care Act includes a program that creates Accountable Care Organizations, or ACOs, where this antidisruptor sentiment could not be stronger. ACOs, purported to be an innovative care delivery and payment model where physicians better coordinate, are more accountable for care management and can even profit from savings they create, are inadvertently too closed and inefficient.

Owing to their complex nature it is very hard for ACOs to be financially and clinically successful. In part this is because the program is largely closed off from the types of innovation and work flows that could hardwire ACOs to bud, evolve and improve. Rather than introducing a good model and letting industry iterate around it in a hundred different ways, the government too tightly defined exactly how an ACO must form and operate.

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