By Ken Morris, JD
The most unlikely of pairings are taking place across the US healthcare landscape. In a effort to improve patient’s health outcomes and control healthcare costs, hospitals and private insurers are forming Accountable Care Organizations (ACO’s). The most recent partnership is between MaineHealth and Anthem Blue Cross & Blue Shield.
These partnerships seek to leverage how well doctors, nurses and other providers work together to improve patients’ health while reducing cost. The amount of insurance reimbursement will be tied to two key metrics: 1) Whether patient health outcomes meet or exceed key benchmarks and 2) How successful the provider is in reducing costs. Any savings will be shared with MaineHealth. If MaineHealth does not meet the benchmarks it will owe money to Anthem.
This model of risk and gain sharing is a step in the right direction. More work needs to be done, particularly involving the entire healthcare continuum from therapy providers such as pharma and device companies to hospitals to patients and finally to payers. A full throated collaboration with a commitment to reduce the expense associated with healthcare while improving outcomes is the responsibility of all parts of the healthcare continuum.
Time will tell if providers, payers, patients and industry, individually and collectively, accept the call to action.