Health Reform: Do ACOs Go Far Enough?

Accountable Care Organizations (ACOs) have been a central focus within health care reform, but if we are looking for some disruptive innovation to change our health system for the better, do they go far enough?

stethoscopeClayton Christensen, a professor of business administration at Harvard Business School and co-founder of Innosight Institute, a think tank focusing on disruptive innovation, and two of his colleagues don’t think so.

In a Wall Street Journal op-ed, they wrote that the ACO model’s inherent flaws doom them to failure unless significant change occurs. While they concur that the US needs disruptive innovation for health care, they feel ACOs are not what’s needed.

So what changes are needed, according to Christensen and his colleagues?

Significant change in physician behavior: “The first untenable assumption is that ACOs will be successful without major changes in doctors’ behavior.” Doctors’ behaviors have “been shaped by decades of complicated interdependencies with other medical practices, hospitals and insurance plans. Such a profound behavior shift would likely require re-education and training, and even then the result would be uncertain.” They question whether ACOs as they are currently built are “equipped to transform physician behaviors on the scale that is needed.”

Patient engagement: “The second mistaken assumption is that ACOs can succeed without changing patient behavior. In reality, quality-of-care improvements are possible only with increased patient engagement.” Yet ACOs are designed to allow Medicare patients to obtain care anyway they choose, so there are few tools such as preferential pricing or discounts that ACOs can use to patients to steer patients to the most effective providers.

How can “ACOs hold caregivers accountable without requiring patient accountability”?

The op-ed authors also suggest that providers consider opportunities to shift care to less expensive venues, and cite the example of Minute Clinics where nurse practitioners can deliver excellent care. This involves breaking down silos and bringing out-of-the-Medicare-box thinking to any change efforts. They urge health care professionals to “make fuller use of technology to enable more scalable and customized ways to manage patient populations” such as more widespread use of telehealth.

As Lifesprk’s Advisory Board member Rick Moody, formerly the Director of Academic Affairs for AARP, likes to stress, change rarely comes from the larger institutions; instead it comes from the margins. It is up to us – small groups of like-minded people – who will help to structurally change the face of health care, and provide the disruptive innovation that is so desperately needed.

Surgeon and author Atul Gawande in his New Yorker article Testing, Testing encourages people to start with pilot efforts for change: test, possibly fail, learn, and test some more rather than looking for a grand solution. Engage someone who knows the issues and whom others will trust – show rather than tell what you’ve learned, and share it willingly with others. The progress will spread.

Lifesprk developed our Lifesprk Experience™ model to fundamentally change the traditional health care approach. We have begun, but know that we cannot do this alone. Isolation is fatal. Our goal is to seed the dialogue and opportunities for these kinds of discussions among like-minded professionals.

So who’s with us on the margins – ready to break through silos and create some disruptive innovation?