Health Care Reform and the ACO

Health Care Reform and the ACO might be an answer to keeping costs under control at least somewhat.  ACO is the acronym for Accountable Care Organization, which despite the name is not another government agency.

I should have been a Specialist!

The idea is to coordinate care through provider-led organizations with a strong emphasis on primary care.  Wouldn’t it be nice if you have a child with asthma and there was more money spent on educating a family about how to react when an attack occurs or better yet, how to prevent one from happening in the first place.  Once you get to the emergency room and possibly admitted to the hospital, the price tag is extremely high.  But if you learn how to prevent it or treat an attack before if gets out of control, not only can you save money (which of course isn’t the most important thing when your child can’t breathe) but it reduces the stress of the situation.  Let’s face it going to the emergency room is something you want to avoid.

A NOVEL IDEA-EDUCATION

Chronic illnesses can be kept under control if you have the right education for the most part.  It’s the lack of proper care and management of diabetes for instance that become very expensive including amputations, dialysis and kidney replacements.

The other issue we face today is shortages in accessing primary care physicians.  Doctors graduating today think more about becoming specialists instead of primary care doctors and why not when you can make three times as much money as a specialist.  Specialist cost more money which drives up the cost of health care.  I’m not saying they aren’t necessary in any way shape or form, but if it’s easier to access a specialist than a primary care physician because of a shortage, it’s the road we’ll end up taking.

BUT WILL IT REALLY WORK THIS TIME?

A pilot program started with the CalPERS program in January 2010 with a promise of a zero increase in premiums by Blue Shield.  Check out this article by Paul Markovich at the Chronicle.  Wouldn’t it be nice to see a zero increase in your premiums or heck anything smaller than what you’ve seen in the last few years!

ACO’s under Health Care Reform have the potential to really help us.  The design of ACO’s will look somewhat like HMO’s use to look like in the “olden days”.  It really was a good theory although so many people had bad experiences with things like referrals and feeling like you were at the mercy of the HMO’s decision maker when you needed specialty care.  ACO’s would be rewarded for positive health outcomes even if they never see the patient.  This should produce an integrated delivery system and would in the long run produce more primary care doctors who oversee our care.

NO WAY, NOT GONNA DO IT!

In today’s world, larger employers are able to incorporate disease management and wellness programs into their employee benefit programs, but small employers don’t have that advantage.  Insurance carriers are sensitive to the escalating cost of the delivery system.  After all they are being held accountable to keep their expenses down as a result of Health Care Reform.  Some carriers already have products available with subsets of providers contracted to keep costs under control.  But we haven’t gotten used to thinking that way yet.  We still want our freedom when it comes to choosing.

One thing is for sure, everyone realizes that unsustainable increases in cost are simply that; unsustainable.  Unless our country does more to encourage chronic disease management, the cost of health care will continue to climb and as consumers we can’t afford that.  It’s very likely that given the creativity of people in general there will be some great options in the future.  I’m actually almost excited!