Originally published at: https://thejournalofmhealth.com/the-affordable-care-act-should-be-the-accountable-care-act/
Names matter. People proudly display the name of their favorite brands across their clothes, cars and prized possessions. Big brands invest big money into creating the perfect name that resonates with their target market and makes them want to buy. On the other hand, bad names spoil the reputations of the best brands, becoming sources of ridicule and fodder for late night comedy.
So given the long-awaited, desperately needed healthcare reform in the U.S., why did things go so terribly wrong with naming the ACA? Also known as Obamacare, the very name of the Affordable Care Act has provoked conflict and debate for a decade now.
A simple name change from the Affordable Care Act to the Accountable Care Act could have garnered greater public support and buy-in by focusing on the benefits of accountability rather than its affordability.
After 10 years of the Affordable Care Act, we’re seeing that the legislation included in the ACA is resulting in more accountable care. While the future of the ACA and healthcare in America is still uncertain, one thing is for sure: holding healthcare providers and insurance companies accountable for health outcomes will lead to healthier patient outcomes, lower systemic costs, key process improvements, and ultimately—yes—more affordable care.
It’s time to make even better use of today’s tech to prevent disease as much as possible, and to hasten patients’ full recoveries. Anything less is unacceptable.
Let’s take a look at the myriad benefits of accountable healthcare and the technology that makes it possible.
Accountable Care Rewards Care Coordination
Accountable healthcare rewards providers for focusing on proactive, preventative measures that keep patients healthy, which typically requires care coordination.
Take the Comprehensive Care for Joint Replacement (CJR) model for example. It’s designed to reduce costs of Medicare beneficiaries who receive hip and knee replacements without sacrificing quality of care. It incentivizes hospitals, physicians, and physical therapists to improve the quality and coordination of care from surgery through recovery so patients can recover better and require fewer costly readmissions.
Between 2016-2018, CMS reported a $61.6 million estimated savings (2% savings) while maintaining quality of care and improving unplanned readmission and complication rates. If more hospitals adopted this model for other episodes, those that provided the best and most efficient care would continue to thrive. And those that remained unable (or unwilling) to coordinate care would not. This is not a bad thing–our goal should always be to improve quality of care.
Accountable Care is Proactive
Preventing avoidable diseases and unnecessary hospitalizations should be just as high of a motivator as treating and curing disease.
According to the CDC, chronic diseases that are avoidable through preventative care — such as type 2 diabetes and high blood pressure—account for 75% of healthcare spending in the U.S. Of course maintaining a healthy diet with regular exercise can prevent these and many other chronic diseases. But so can screenings, tests, and annual physicals where physicians can intervene before a disease has progressed to the point of requiring medication. If every person received this kind of recommended preventative care, 100,000 lives could be saved.
An Accountable Care Organization is another model to consider. In the ACO model, at-risk payers take monetary responsibility for delivering health outcomes for a population. If care is affordable, they make money. If care is expensive, they lose money. The end result is the emergence of accountable and managed care organizations that take a holistic view on delivering healthcare to a population.
Accountable Care is Collaborative
In an ideal world, patients would always follow through with their physicians’ recommended care plans. But for many reasons, they don’t: they forget, it’s too expensive, they don’t understand the significance, etc. People most at risk of bad outcomes caused by medical non-adherence are those with chronic diseases.
Chronic diseases are typically managed by prescriptions. But 20% of prescriptions are never filled and 50% are taken incorrectly, so patients’ health doesn’t improve. Instead, it worsens and leads to more hospital stays, more comorbidities, and reduced quality and length of life. Non-adherence also creates additional health care costs, to the tune of $100-$300 billion. Much of this spending is avoidable. For example, the American Journal of Managed Care (AJMC) estimates that non-adherence in patients with diabetes accounts for $24.6 billion in avoidable costs!
However, those who receive collaborative care and long-term follow up, such as patient education, point of service counseling, refill reminders, home blood pressure monitors, electronic reminders, are 15% more likely to adhere to their prescriptions.
Collaboration between physicians, home health care, and pharmacists can help reduce the rate of patient non-adherence and save lives. It requires knocking down data silos. It requires creative thinking. And it means the big players across the care continuum need to play well with others.
Accountable Care is Accessible
The best care in the world is useless if it’s not accessible. The barriers to care are well known: health insurance, transportation, personal resources, perception, language. But these barriers are not insurmountable. We need to adopt a mindset that looks for holistic solutions that can engage patients where they are and when they need it, and that remove the obstacles patients face.
At the same time, we can’t hold providers responsible for outcomes if they don’t have the tools they need to interact with people. The need for efficient, enterprise level tools became especially clear during the pandemic, when people needed to minimize the number or length of physical interactions they have.
Let’s Make It Work with Virtual Care
Today’s technology gains can remove most—if not all—of these barriers to care. That’s why our focus needs to be on creating more efficient tools, systems, and processes that engage patients, that help our nation’s healthcare professionals be “out there” preventing sickness instead of waiting for sick people to come to them.
Strategic telehealth is a way forward and the future of preventative, accountable care is virtual. Strategic telehealth makes it easier for people to connect to the right providers at the right time. It creates smart systems that save both clinicians’ and patients’ time. It reduces barriers to care.
Above all, strategic, integrated telehealth can make accountability in healthcare the norm. And only then will it improve the standard of care while also driving down costs. Focusing on affordability misses the point. Accountability must be the goal — don’t be satisfied with anything less.
Article by Brian Yarnell, Founder and President Bluestream Health