Dr Farzad Mostashari Outlines Challenges to Sustainability of ACOs

former National Coordinator of Health Information Technology and co-founder and chief executive officer of Aledade.

There are 3 main risks to the sustainability of accountable care organizations and the move to accountable care, said Farzad Mostashari, MD,

Transcript (slightly modified for readability)

Is the ACO/accountable care movement sustainable?

This is the second go around. The first go around was not sustained. And I think we all have to ask ourselves is this more of the same? Or is there a reason why this time is different. And I believe this time is different, but it’s not just going to happen, we have to make it happen. And this time is different for a couple of reasons.

One, because of the data and analytics tools we have now that we could only ream of before that can actually help us get better care at lower cost. It’s not a less is less situation. Less can be more but you need much more sophisticated analytics than 20 years ago to be able to put in that service. And I think the policies are a little smarter.

But I do think there are 3 risks to sustainability for ACOs and this has absolutely nothing to do with Medicare regulations. The first is the risk that patients will feel like they’re getting less in order to make profits for the providers. We cannot ever stint on care. There are plenty of ways to get better value by doing things better—giving the patients more access, better care, not less needed care.

The second risk is that providers who are part of these systems that there’s no transparency for them. At the end of the day they don’t know they didn’t get any money and they don’t know why they didn’t get any money. And I worry a lot about that both on the part of health plans’ lack of transparency and data and their code. But also in terms of ACOs not being transparency with the practices in terms of what the costs are and how the returns are going to get divided up. Governance and transparency on the provider side.

And the third, the biggest risk, is that the payers say, “You know we’re not really seeing results from this, let’s go back to just squeezing down the rates.” And we need to be able to deliver results in terms of lower total cost of care for a population that’s getting better health and better quality.

You know I see too many folks just kind of rolling the device or having monthly meetings but not really fundamentally changing how healthcare is delivered.