Posts in Health Care Reform
Can ACOs Make Money?

If improved coordination and value-based reimbursement are going to be among the pillars of healthcare reform, then Accountable Care Organizations will be one of the most reliable means of getting there. Once we arrive we’re going to find a landscape filled with cost and quality benchmarks, closely measured accountability, risk stratification, population health management, re-aligned incentives and alternative compensation models. In the midst of these challenges and new approaches the one question all of us are asking is, “Can ACOs make money?” The simple answer seems to be … “It depends.”

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Dr. Peter Anderson Speaks: FPM Article Reports Long-term Benefits of the Family Team Care Model

“Three years out of residency in 2008, I was struck by the fact that, compared with the latest surgical techniques and inpatient procedures, the typical primary care outpatient visit had not seen a lot of innovation. In addition, as a poor typist, I was struggling with my first exposure to an electronic health record (EHR), which was further slowing me down.

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Team Care and the Triple Aim

The relationship between healthcare costs and the overall economy exists on a number of dimensions, all of which are difficult to decipher by anyone who doesn't have a serious background in economics. But the one thing we all know is that spending in healthcare has historically risen faster than inflation and just about everything else. Here’s a good way to put it into perspective: If other consumer prices had increased at the same rate as healthcare costs have since 1945 a dozen eggs would cost around $55.

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Overcoming Ongoing EMR Challenges

As a practicing Family Medicine physician I was an early adopter of the electronic medical record (EMR) so I have long and personal experience with its advantages and disadvantages. Now, while working with practices across the country to help them transition to an effective Team Care model, I am also keenly aware of the compatibility and integration problems brought about by the plethora of different vendors and systems. I know I share this EMR frustration with most primary care doctors, so it was particularly gratifying to see the efforts that the American Academy of Family Physicians (AAFP) is now directing toward solving some of the major challenges.

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Gathering and Combining Our Strength

Through the eyes of an individual physician, watching the major organizations representing primary care bring together their collective resources and energies is a gratifying and empowering experience. From the perspective of primary care practices across America and our field of medicine in general, it’s a unique opportunity to develop improved strategies and communications for the future. Toward that objective we received some promising news late last month from Family Medicine for America’s Health, a coalition of primary care organizations (see the list below) that shares a basic vision of the role primary care medicine should play in heath care reform, regardless of the form it may ultimately take.

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The Momentum Continues

Although the concept and basic principles of the medical home were introduced as far back as 1967 by the American Academy of Pediatrics, the current delivery system innovation represented by the Patient-Centered Medical Home (PCMH) is of more recent vintage. And while this model of team-based, coordinated care has many advocates, no one has served as more of a singular champion for the PCMH than Paul Grundy, MD. As IBM’s Global Director of Healthcare Transformation and the president of the Patient-Centered Primary Care Collaborative, Dr. Grundy has spent much of the past decade working with an international network of thought leaders, industry experts and medical practitioners.

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Is there a doctor in the house?

It may not be a full-scale “back to the future” movement, but by every indication the return of the physician house call is a small but growing phenomenon in primary care medicine. In part, this revival is expanding because of the “Independence at Home Demonstration”, an ACA-generated test program studying the effectiveness of treating chronically ill people at home, primarily those with limited mobility. Early reports and common sense are telling us that this now rare but once common practice can play a role in significantly reducing healthcare costs while also improving the quality of care for many frail elderly and chronically ill patients.

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