George A. Huber Op-Ed on Accountable Care Organizations Published in Modern Healthcare

Accountable care organizations are "not the be-all, end-all" of health care reform, wrote Buchanan Ingersoll & Rooney Health Care Consultant George A. Huber in an op-ed published in Modern Healthcare on May 16, 2011.

The accountable care organization (ACO) effort "is broadly and almost universally concentrating on primary-care doctors directing and, inferentially, controlling care," Huber wrote. He specifically cited the lack of regulation regarding hospitals' role in ACOs — "they can be members and participants…but 'not in control,'" — as illustrative of the need for full-scale participation by "insurers, hospitals in patients" who "all must do their part."

Legal, tax and financial challenges are just the beginning for ACOs, which also face "entrenched provider and patient issues with which they must reckon."

"American healthcare has been practiced and reimbursed traditionally on a silo basis. Fee-for-service and DRG reimbursement methods are closely related to the cost of specialty resources and procedures. Unfortunately, there are no real incentives for specialist to collaborate across specialty lines, including those of primary care," Huber wrote.

Still, ACOs are "a start in recognizing the problems and attempting to address them from the healthcare provider side of this multivariable equation," Huber explained. "Insurers of healthcare, for example, should be more than just the financiers of healthcare services. They should also assist ACO providers in the new roles that they are expected to assume."

"The most important variable in the American healthcare system is an educated and informed citizen," Huber stressed, "a process that ideally begins long before their entry into the healthcare system, or entry by someone for whom they are responsible or concerned."

Huber's solution is to "add knowledge of personal health and the American healthcare system" to the U.S. education system.

"Such literacy, if begun and required from grade one through college, would be most useful for politicians, regulators, clinicians, insurers and citizens themselves as patients and caregivers to those they love — a child, spouse or parent," Huber suggested. "Although this is a long-term variable that involves cultural change and will span many political careers, there is an urgency that it begin today."

Students' current education, which generally encompasses physical hygiene education and unhealthy habits and lifestyles, don't touch on the long-term picture.

"[W]hat do they know about illness, disease, chronicity, healthcare professionals, providers, economics, insurance, the elderly, the right questions, who to ask, where to start and so on, until they are actually confronted with a problem and are required to learn as they go," Huber argued.

The topics could be "integrated into the readings, problem solving and exercises of existing curriculums" to avoid burdening schools with financial, teaching and training concerns.

"So, is the ACO the answer?" Huber asked. "Not entirely."

"It is, perhaps, a new approach in helping to better define the problem nationally and in helping to identify other long-term solutions. Past approaches, whether for healthcare research, the provision of healthcare services or healthcare basic individual education, are scattered at best," Huber offered.

"Organized and cumulative knowledge and literacy about healthcare seems to be a way of bringing it all together for better understanding and a better, more rational healthcare future."