Physician groups and health insurers in California are actively working to establish accountable care organizations, but several challenges are associated with the development of ACOs, according to a white paper by the Integrated Healthcare Association, Fierce Healthcare reports (Cheung, Fierce Healthcare, 11/2).
The white paper examined opportunities and hurdles facing health plans and providers in their efforts to adopt ACO practices (Byers, Cardiovascular Business, 11/7).
Key Findings
One of the difficulties in creating ACOs is in linking patients to physician organizations, according to the report. Patients might seek care from physicians who are within their insurance network, but those physicians might be outside of the ACO.
Communication could be another challenge as ACOs try to engage patients in the health care process by providing information about wellness and disease prevention (Fierce Healthcare, 11/2).
According to IHA, exchanging clinical and administrative data in a prompt and complete way between health care providers and health insurers also could present a challenge.
Comments
Even though challenges exist, James Robinson -- an author of the report and Leonard D. Schaeffer professor of health economics at UC-Berkeley -- said it is time to overcome the challenges and fulfill the opportunities offered by ACOs.
Robinson said, "ACOs represent the opportunity to forge a middle ground between the traditional HMO product, which controls cost at the expense of consumer choice, and the traditional PPO product, which preserves choice at the expense of cost control" (Cardiovascular Business, 11/7).
For information on a new IHA tool designed to build on the organization's pay-for-performance initiative, see Monday's feature article.