ACOs: The New Rx for Health Care Delivery?

Medicare beneficiary James Conway, 73, has high blood pressure, a catheter that has led to several urinary tract infections and a condition that causes spinal fluid to build up in the base of his skull. In the last year, he’s been in the hospital four times. Recently, the Berkley, Mass., resident says his care has gotten noticeably better. “We used to be left to our own devices to get somebody to help,” he says, describing how he had to navigate between several different doctors.

Since the spring, however, pharmacists have visited Conway at home to examine his medicines, cut five from an 18-drug regimen, explain what each one does and create a spreadsheet to remind him of when to take them. They also check in weekly, as does a nurse, who helps organize his care and arranged for an aide to regularly change his catheter, something nearly impossible to get done before. “That was unbelievable for me,” says his wife Kathy. “And they all leave their phone numbers with us.”

Conway is part of a so-called accountable care organization (ACO), an experiment that is transforming the way health care is delivered in America. Many of the estimated 27 million people in ACOs aren’t aware they are in one, but do notice that their doctors and other care providers seem more attentive to their needs. That’s because ACOs, entities triggered by the controversial 2010 Affordable Care Act (also known as Obamacare), force hospitals, doctors and other health care professionals to rethink how they deliver care so it is more coordinated, better quality and lower cost.

How? Obamacare directed Medicare, the nation’s largest health insurer, to change its fee-for-service payment system, which tends to promote more tests and treatments when less care (or more preventive care, or better-coordinated care) would often produce better results at a lower cost.

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