I had the privilege of attending the Connected Health Symposium 2011 in Boston on October 20-21. One of great ideas from that Symposium was to debate the key topics in healthcare today including the idea of Accountable Care Organizations and their ability to drive quality up and costs down. At the heart of that idea is whether or not ACOs will produce more accountable patients. This topic was debated by Timothy Ferris, MD, Medical Director, Mass. General Physicians Organization, Jonathan Gruber, PhD, Professor of Economics, MIT and Dana Safran, ScD, Senior Vice President, BCBSMA. As you might imagine, Dr. Ferris took the negative point of view arguing that ACOs won’t produce accountable patients due to the need for new incentives. Dr. Safran took the affirmative argument that ACOs would produce accountable patients by reducing fragmentation and chaos in the healthcare system. Dr. Gruber, the economist, argued that the only way to change patient behavior was to use price signals, i.e. a higher cost burden. Dr. Gruber noted that “patients hate paying when they go to the doctor” and that was the only way to produce accountable patients.
Dr. Ferris: ACO Will Not Produce Accountable Patients
It was not surprising to see that Dr. Ferris was pessimistic about producing accountable patients. He felt that three systemic items must change:
- Access to care, the design of care and the measurement of care. Dr. Ferris felt strongly that a mechanism for virtual visits must be created with both patient and physician portals to improve access to healthcare information and lower the cost of patient and physician interactions.
- He wanted more from electronic health record systems to improve the decision making process and ease computerized physician order entry.
- Most importantly, Dr. Ferris argued that measurements and reporting were keys to improving accountable patients including quality metrics, clinical outcomes and patient satisfaction. He concluded that benchmarking, variance reporting and dashboards were improvements required to improve patient care.
Dr. Safran: ACO Will Increase Accountability
Dr. Dana Safran of BCBS of Massachusetts was positive that ACOs would increase accountability across the entire continuum of care including patients. She noted that the chaos and fragmentation of healthcare industry must be addressed by aligning clinical and financial incentives to make accountable care organizations work. Dr. Safran fielded a question from the floor about whether payers have enough interest to address the accountable patient due to “churn” or the turnover of patients covered over a longer period of time. Her response was that “payers have a large incentive to look for effectiveness in the long term despite churn.” Dr. Safran went on to note that one of the challenges of accountable care was that “doctors are responsible for delivering less to patients.” This statement provoked an immediate reaction from the physicians in the audience and Dr. Ferris. One emergency room physician reacted that capitation didn’t work in the 90s and it won’t work now. Another doctor pointed out that reimbursements today are too low to attract primary care physicians.
But what do the patients think?
Clearly, it was a lively debate with the doctors arguing to retain the current fee for service status quo and the economist/healthcare payer arguing that things must change. One startling fact that Dr. Jonathan Gruber noted was that a middle class family income went up by $28,000 in the last 10 years but due to increased healthcare costs, they only pocketed $93. Clearly, employees are facing higher cost sharing but this fact drove the point home. In the course of this debate, no one argued that we didn’t need to get control of healthcare costs and that those costs were a drag on the current economy.
The only voice missing in the debate was the patient. Several of the folks on social media noted the absence and discussed that need in the future. I’m curious what regular folks think about this issue – what is needed to get you to be more accountable about your health? What incentive really motives you?
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