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Obamacare's Accountable Care Organizations Are Too Closed And Inefficient

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POST WRITTEN BY
Jonathan Bush
This article is more than 9 years old.

This story appears in the June 15, 2014 issue of Forbes. Subscribe

It is axiomatic in the technology sector that disruptors fuel the breakneck pace of innovation. These are thinkers and dreamers who look at the established players and the status quo and see, clear as day, that there is a better way. They see a better way of programming thermostats, controlling light switches, listening to music and doing a million other daily tasks, and our lives are infinitely better for it.

For reasons that keep me up at night and make me want to bang my head against a wall, it seems similarly obvious that disruption in health care might as well not exist. Sure, our experiences with health care are horrible expressions of our humanity and it seems that there must be a better way, but the message from all sides is loud and clear: Disruptors need not apply.

The Affordable Care Act includes a program that creates Accountable Care Organizations, or ACOs, where this antidisruptor sentiment could not be stronger. ACOs, purported to be an innovative care delivery and payment model where physicians better coordinate, are more accountable for care management and can even profit from savings they create, are inadvertently too closed and inefficient.

Owing to their complex nature it is very hard for ACOs to be financially and clinically successful. In part this is because the program is largely closed off from the types of innovation and work flows that could hardwire ACOs to bud, evolve and improve. Rather than introducing a good model and letting industry iterate around it in a hundred different ways, the government too tightly defined exactly how an ACO must form and operate.

For example, as they stand now, rules require that ACOs be at least 75% provider-controlled, so physicians must do the heavy lifting when starting one. The reality is that, once formed, an ACO requires extensive management, technical resources and granular insight into, and analysis of, patient data. Many of these requirements are beyond the realm (or interest) of your average physician. That's made some independent physicians flee to hospitals and large health systems for employment, an avenue they see as their only way into shared savings models. This rampant physician employment trend is not only reducing patient choice in health care, it is also driving up cost--the very opposite of the intended effect of ACOs.

The ACO model, if meant to survive and thrive at mass scale, is ripe for disruption. Most independent physicians want to focus on what motivated them to attend medical school in the first place: caring for patients. They are not interested in jumping through administrative hoops to form an ACO, only to then analyze steady streams of data on thousands of patients, to then track and submit data to satisfy dozens of quality measures, to then process and divide group bonus payments. And no one wants them doing this work, either. Especially when there are operational experts and technology innovators at the ready to do these tasks more efficiently and at scale.

Our nation's care providers are being squeezed at every angle as they navigate through the very narrow requirements set up by the government to participate in new care models. If the government truly wants to define the ACO model as an innovative care delivery mechanism, it must let innovators swirl around it to tackle and improve upon the concept's early phases. Yes, at the core of an ACO is the work of the physician, but any nonclinical work that a physician can't or doesn't want to do, including formation of an ACO in the first place, should be allowed to be managed, processed and completed elsewhere.

Unfortunately, ideas like these are too often met with skepticism in Washington, D.C. One of the few points of agreement in that town is that health care is barreling down an unsustainable-cost path. This is a reality that cannot be addressed by maintaining the status quo. We need to let innovative solutions and efficiency in the door. Can we persuade our policymakers to let the disruptors swirl?