Accountable Care Organizations

The Affordable Care Act (ie: Health Reform Bill) is full of new changes for our current health care system in the United States. Innovations within the act are designed to increase market competition, increase access and quality of care, and decrease costs. Every few months between Jan 1, 2010 and Jan. 1, 2015, something new happens. One new and exciting program is the development of Accountable Care Organizations, which goes into effect January 1, 2012. What is an Accountable Care Organization you may ask? It is an incentive for health care providers to reorganize their delivery systems and care management pathways into INTEGRATIVE Health systems. ACO's are projected to save as much as $960 million over the first three years alone!

So who does this effect and what does it mean?

ACO's are programs designed to incentivize Medicare health providers. Group practices, networks of individual practices, and partnerships/joint ventures between hospitals and professionals are the primary organizational structures eligible for ACO status, and thus shared savings benefits. Each ACO must meet quality measures in patient/caregiver experience of care, care coordination, patient safety, preventative health, and population risk management for Medicare patients.

This is a huge step in the right direction for Integrative Health, but still leaves much room for improvement. First, Integrative Health systems don't guarantee Integrative Medicine on a clinical level, only integrated administration and a change in the relationship of providers (ie: Doctors, Nurses, etc) with the system. However, both of these aspects are the critical foundation for creating integrated medical care within the integrative health system. One of the major hurdles for Integrative Health and Medicine is a lack of successful models and research into what works and what doesn't. Integrative Healthcare requires a very different thought process and approach towards care. Providers and Payers (ie: insurance companies) want to know if an investment into this kind of radical reorganization of our health systems is worth it; is there an adequate return on investment? For the past 20 years, payers and providers have been playing hot potato and insisting someone else "go first". The government, in this case, is stepping in and saying they are willing to bet that this not only works, but is better. They are putting the money and time into a program that will give the information private health systems and insurers/payers need to go forward and support and create Integrative Health systems and reduce the investment risk of doing something "unproven".