The other health care revolution: accountability

Not since the advent of Medicare in the 1960s has our nation’s health care undergone the kind of sweeping transformation we’re seeing today.

While the Affordable Care Act and the millions of people who are newly insured are grabbing most of the headlines, there is another important story in health care that’s not to be missed. Physicians, hospitals, and health insurers are now joining forces collaboratively to create new ways to raise the quality of care, lower costs, and increase patient satisfaction. 

These new approaches to care are important because well-respected studies estimate that 30 percent of every health care dollar goes towards care that is ineffective or redundant. With national spending on health care topping $2.8 trillion each year, it’s imperative that we find ways to raise quality and rein in costs on behalf of consumers and employers.

That’s why health insurers are radically changing how they compensate physicians and hospitals, moving from an antiquated model which pays for the quantity of services provided – and does not consider quality or effectiveness – to a new model that rewards improving quality and lowering cost.

One such new model is Accountable Care Organizations (ACOs) – groups of doctors, hospitals, and other health care providers that come together to provide highly coordinated, high quality care to their patients.  The tremendous potential of ACOs is exciting for everyone in health care, and for consumers and employers. 

A survey of Blue Cross plans throughout the United States released last month highlights the size of the investment being made in these and similar initiatives.  Altogether, these plans are spending more than $65 billion a year—about one in five medical claim dollars—on value-based programs like ACOs.

Here in our region, more than 90 percent of the health care systems are participating in an ACO payment model initiated by Independence Blue Cross. The initial results are extremely encouraging:

  • Nearly 90 percent of the hospitals participating lowered readmission rates, with an average reduction of 16 percent.
  • 100 percent of the participating health systems improved on at least one hospital-acquired infection measure or received a top distinction from the Pennsylvania Department of Health for infection control.
  • Nearly all participants scored better in measures that assess patients’ experience during their hospital stay, such as how well patients understand the information they receive about recovery before they are sent home.
  • Half of the hospitals participating successfully reduced their medical costs, based on total medical costs for the defined group of members. The customized targets are set based on historical utilization and costs.  

When doctors, hospitals, and other health care professionals, and health insurers work together to boost the quality of care, lower costs, and raise patient and physician satisfaction, everyone wins. 


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