Defining the “Accountable” in ACO
What does accountable mean? The Oxford Universal Dictionary gives us a straightforward definition—“accountable: liable to be called to account, responsible; also, simply to be counted on.” As a physician, and consistent with this definition, I have always believed I am accountable for any advice given to a patient or action taken on their behalf. By extension, all of us at Fletcher Allen are collectively accountable for the care rendered at our facilities by our caregivers. However, this is no longer an adequate degree of accountability, as we are being called on to take responsibility for the quality and cost of care for populations of patients even when the care is provided by other physicians at other hospitals.
How is this possible? The federal government is incenting provider groups to take accountability for populations of Medicare beneficiaries through the formation of Accountable Care Organizations (ACOs). The idea is that if most or all of the different provider organizations in a region together take accountability for the health and heath care needs of the people in that area, quality will improve and costs will decrease. Fletcher Allen, in partnership with Dartmouth-Hitchcock Health and other provider organizations across Vermont, has formed a statewide ACO called OneCare Vermont with just these goals in mind.
I find many comparisons between health care and other industries tenuous, but let me give one a try in an attempt to clarify the ACO concept. Everyone would agree that Ford is accountable for the quality and cost of the cars and trucks produced under their brand. Yet, each vehicle is assembled from thousands of component parts produced by the myriad of companies with which Ford has contracted, but does not own. Ultimately, the quality and the cost of the product depend on smooth working relationships between the suppliers and the assembly plant. Ford’s entire production network has aligned incentives.
In forming OneCare Vermont, a broad network of Vermont health care providers has come together to take accountability for the health and heath care needs of a significant segment of Vermont seniors. Like the suppliers in my example, the providers are united not by corporate ties, but by aligned incentives to keep people healthy and deliver the highest-quality health care for the lowest possible cost. If providers are to be counted on to meet the health care needs of any of our citizens, OneCare or other provider networks will become an essential component of Vermont’s delivery system. That’s what accountable means.
John R. Brumsted, M.D. is the President and Chief Executive Officer of Fletcher Allen Health Care and Fletcher Allen Partners.