A letter from the editor-in-chief of The American Journal of Accountable Care®.
There is no doubt that 2020 will long be remembered as the year when the SARS-CoV-2 virus led to a pandemic of coronavirus disease 2019 (COVID-19), causing significant morbidity and mortality and changing almost every dimension of life and activity for individuals, governments, and commerce around the globe. Looking toward 2021, it seems likely that the new year will be busier than ever for health policy and health services research, and The American Journal of Accountable Care® (AJAC) stands at the ready to publish and disseminate critical research and expert thinking about the challenges that face the health of populations and the operations of health and public health systems. As the year ends and results from several successful phase 3 COVID-19 vaccine trials are used in submissions to the FDA for emergency use authorizations, it will be critically important for the research and policy community to follow a number of important issues pertaining to the vaccine in the coming year. Important topics include policies for allocating initial scarce supply to the most vulnerable populations, willingness of the individuals to trust the scientific and regulatory approval process and get vaccinated, and the ability of the supply chain and providers to keep up with vaccine demand. Ethical issues are critically important, such as access to vaccines in underdeveloped and developing countries, as well as for disadvantaged populations at home in the United States. Of course, it will also be important to monitor the real-world effectiveness of COVID-19 vaccines to determine if the promising results in the phase 3 trials hold up in the larger population and to better understand the length of protection from COVID-19 that the vaccines afford.
As if these questions are not enough, there will be additional critical questions to investigate as the vaccines eventually provide both protection and relief from COVID-19 for significant portions of the population. Specifically, it will be important to see if and how health care systems in the United States and around the world are able to rebound, and whether the heavy toll of the pandemic results in significant investments in public health infrastructures in an attempt to prevent a similar situation in the future. Evidence regarding the health impact of delayed care—such as missed well and preventive care visits during the pandemic—as well as whether rates of telehealth visits and virtual consults continue in the postacute period of the pandemic will be important to track. It is virtually certain that there will be unexpected new findings that will be attributed to the pandemic that in time may seem obvious, but at the moment may be merely hypotheses. For example, at a recent visit to an eye clinic, an optometrist predicted that the pandemic will have a significant impact on vision, particularly for young students or working professionals who have endured increased use of computers and other online devices and technologies to study and work. In another recent conversation, an orthopedic surgeon mused about the possibility that work-from-home policies, likely in spaces that were not ergonomically designed, could increase the likelihood of musculoskeletal and other related conditions unless the home workspace allowed for some protective impact, such as more convenient ability to get up and move frequently. There is no doubt that we will see a rash of research studies and evidence that report on the impact that the pandemic has had on the health of populations, and ultimately the care that will be needed to be delivered—and paid for—going forward. AJAC welcomes these contributions as an outlet that publishes good empirical science in a manner that is accessible for health care professionals and policy makers.
Speaking of public policy, the new year will bring a new presidential administration in the United States, as well as leadership changes in critical cabinet positions and at some federal agencies responsible for health care financing, organization, and delivery, as well as public and population health. During any shift in administration, there are key changes in health policy to track, and one expects this to be even more pronounced coming out of COVID-19. As several articles published in the December issue of AJAC illustrate, new evidence to evaluate current policy approaches, or to suggest new approaches, is what occupies the pages of our journal. In the current issue, for example, there are articles that address critical components of the health care financing and delivery landscape in the United States. An article by Clark et al compares the performance of 2 types of Medicare accountable care organization (ACO) models: the shared savings model and the Next Generation ACO model. Another article by Gascon et al focuses on the process of developing bundled payments for specific clinical conditions, an approach that has garnered significant attention as remedy for the perverse incentives of the fee-for-service payment system. An article by Highfield et al puts forth a conceptual framework for addressing the social needs that are believed to contribute to the health of patients, such as safe housing, food security, and protection from domestic danger. Given growing levels of income inequality in the United States, as well as the economic impact of the pandemic, this issue is now more important to understand than ever. Finally, in a summary of a recent panel session at the National Association of ACOs meeting, Laura Joszt highlights views about the effectiveness and future of ACOs by the current and immediate past chairs of the Medicare Payment Advisory Commission: Michael E. Chernew, PhD, and Francis J. Crosson, MD, respectively. Importantly, 4 changes are suggested to make Medicare’s ACO program more impactful.
In closing, the quality of content in our current issue illustrates the importance of the work we publish at AJAC. As mentioned earlier, we look forward to publishing important future research, and as always we invite our readers to formally share their thoughts on these published articles in the form of commentaries or informed opinion pieces pertaining to public health policy or clinical heath practice.
Dennis P. Scanlon, PhD
Editor in Chief