Rob Mechanic: ACOs Are Perfectly Positioned to Better Help High-Need, High-Cost Patients

The way accountable care organizations are set up makes them a perfect system of care for high-need, high-cost patients who might otherwise fall through the cracks of traditional delivery models, said Rob Mechanic, MBA, senior fellow at the Heller School of Social Policy and Management at Brandeis University and executive director of the Institute for Accountable Care.

What is the role accountable care organizations can play in caring for high-need, high-cost patients?
First of all, the system is really failing high-need, high-costs patients. So, these are people who have complex illness, they’re frail, they’re socially isolated, they may have a lot of social factors that are affecting their health and their life, and they fall through the cracks of the traditional systems.

Now the ACOs, you really need a system of care to do the best that you can for these patients. They’re very expensive they are not only high utilizers but high utilizers of care that is avoidable care—a lot of unnecessary care—and so the ACO is our system of care. So, they’re well suited to try and fill those gaps.

The other issue is that a lot of the things that this population needs are not covered under traditional payment models or they’re under reimbursed. So, a home visit—physician visits at home, nurse visits at home—that don’t fit into the typical Medicare home healthcare visit. Other kinds of social supports—getting people appropriate food or helping them with housing. Those are things that aren’t paid for but in a global budget model, as in an ACO, there’s really more opportunity to be creative and do the right things for the patient and not just the things that Medicare will pay for. So, I think ACOs are very well positioned to help this group and it’s a real need in our system.
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