Unrealistic expectations could cloud ACA progress
Since well before the ACA passed, Obama administration officials have held up physician-driven, innovative institutions like the Geisinger Health System, Mayo Clinic and Cleveland Clinic as the standard to which the nation's healthcare system ought to be held.
Institutions like these seem to be meeting the elusive goal of delivering quality care while keeping prices on track. But while they offer inspirational leadership, they also set a bar that is probably too high—for the moment at least—for the majority of healthcare organizations, which are struggling to handle the logistics of switching over from fee-for-service to value-based payment.
It's good to have a long-term vision of how the healthcare system can be changed to offer better value to all involved, certainly. But the institutions that are consistently delivering on cutting-edge approaches have multiple advantages over those that don't, including sophisticated IT infrastructure delivering needed data, an engaged corps of doctors that support these changes and a long history of innovation.
Value-based payment for care delivery, and care packages that support this approach, are certainly on their way. But it's going to take a great deal of time, investment and learning before typical health systems figure out how to make these changes work.
A work in progress
There's little doubt policymakers are advancing the case of efficient new care delivery models. In fact, CMS just announced that 4,122 providers are being added to the first phase of its Medicare Bundled Payments for Care Improvement initiatives, joining a group of 2,412 providers who have already signed on to the program.
At this stage, the program doesn't require participating providers to bear risk, but rather to experiment with four different payment models designed to reduce costs, boost quality, help improve doctor engagement and give hospitals a window into understanding the total cost of care. CMS will doubtless escalate into risk-bearing schemes over time, but it should be a slow, deliberate process.
And of course, the countless ACO deals being struck by payers are pushing health systems and affiliated medical groups in the same direction, steering providers into a wide range of risk-bearing arrangements that demand cost savings and quality improvement. While these models are fairly new, some have already begun to bear fruit, as the success of a new Independence Blue Cross ACO program demonstrates.
Still, I'd argue that it's unwise to rely too heavily on emerging models of care to make immediately needed changes in the cost structure and care quality delivered by U.S. providers. By all means, let's shoot high, but over the short term, a focus on incremental changes that make a day-to-day impact should remain a central focus of reform efforts. We can't afford to ignore the potential for good results in an effort to produce the great.