While we ponder what the court will do about the Affordable Care Act, let’s take another look at one aspect of the law already in effect, the accountable care organizations. We’ve spotlighted good coverage of this in the past, but it’s a concept that still has people confused. Plus, if the court strikes part of the law but leaves sections standing, most of the delivery system reforms – including ACOs – are likely to continue, meaning you may want to cover ACOs in your area.
Tony Leys of the Des Moines Register recently took a look, in a story that did a nice job of mixing local examples and national context, and of blending narrative “real people” stories with a larger explanation. He got lots of space to do so – a mainbar focusing on doctors and patients and a small sidebar, explaining the policy in plain English. Even if you don’t get the space he got, the sidebar works really well as a place to translate the wonky “what is an ACO” that helps the reader but doesn’t slow down the story as much. Good approach for complicated stories.
The story came out in May and, unfortunately, we can’t link to the whole thing. (If we find a way to do so, we’ll update this.) Update: The Des Moines Register has restored the story so our readers can see it. We’ll describe the structure of the story and provide some key quotes that give the reader a sense of what an ACO is.
“Supporters of a new method of paying for health care hope to hear more stories like Dave Kalous’.
Kalous, 57, was diagnosed this spring with a potentially deadly heart ailment. Since then, his doctor and other medical professionals have spent hours explaining the disorder and discussing ways he can try to live with it. Whenever he has a question, someone from the hospital gets right back to him with an answer. Every week or two, a nurse comes to his home to take his blood pressure, ask about his pain and check for complications.
He believes that without such support, he would be struggling more. “I definitely would have returned to the hospital more often,” he said.”
Trinity Regional Medical Center last January founded an ACO, in which hospitals doctors and other providers are judged on “how well their patients fare” not just how many tests and procedures they order. This program is under Medicare but private insurers and large hospitals are forming similar organizations. (Check with the big health plans in your area, like UnitedHealthCare, the Blues, Wellpoint, etc., to see what they’re doing).
Leys also describes how and why some doctors are warming up to the concept.
“Kalous’ physician, Dr. Timothy Ihrig, said he’s glad to see the country move toward a system that rewards doctors for talking at length” with patients about the pros and cons of complicated and expensive treatments.
“We’re in a system now that perpetuates things because they can be done. But should they be done? That’s what we should be asking,” said Ihrig, a palliative care specialist.”
Leys also explains why ACOs are not equal to HMOs … and that quality measurement, the literal concept of “accountable” care is a big difference. Patients also have more choices. And he outlines which patients an ACO focuses on first.
“The Fort Dodge program is focusing first on patients who have chronic health problems, such as diabetes, cancer or heart failure, that are likely to cause multiple hospitalizations. Such people tend to be by far the most costly patients, so they represent the best opportunity to save money.”
He also talks to some national experts (you could get the same result from more local experts at your state universities’ health and public policy programs) about the pros and cons. One of the big worries – as we’ve said before but it bears repeating – is that ACOs may encourage greater consolidation, either more hospital mergers, or more hospital clout over physician groups. It’s worth mentioning in an ACO story and your state hospital association is probably a good place to start.
Editor’s note: Bruce Japsen writes today about the emergence of ACOs for Forbes.com in “Life After The Supreme Court: Accountable Care Catches Wave.”
Resources for explaining Supreme Court’s ACA decision
Webcast: To assist reporters who will need to localize the decision and what it means for their states and communities, AHCJ will host a one-hour online roundtable on Friday, June 29, noon ET, to offer suggestions on stories you can pursue right away and in the weeks ahead.