Monday, September 20, 2010

More on Accountable Care Organizations

The field of health care has always been vulnerable to fads and buzz words and the latest one is Accountable Care Organizations, with the inevitable acronym ACO. In brief, an ACO is an organization that can be held accountable for the total health care of an individual or a group. It responds to the lack of overall responsibility and accountability that patients experience when they are under the care of multiple physicians and institutions.

The ACO concept describes a role that should have been filled long ago but has not, due, in my opinion, to our persistent reluctance to institutionalize the practice of medicine. We are wedded to the myth that every doctor knows everything about his or her branch of medicine there is to know and can be counted on to do the right thing without supervision. An ACO presumably would counter that belief by creating an institution that would organize and oversee the entire process of health care, including the physician component. The most likely basis for an ACO would be a hospital.

Economist and fellow book clubber Bill Marden recently called to my attention a delightful animated film clip on the subject of ACOs created by Centura Health, a Colorado health system, and distributed by the Internet news agency World News by way of You Tube. In it, a hospital administrator is speaking with woman identifying herself as being from the health reform help desk. The administrator wants to have the health reform legislation explained to him. When told it is a thousand pages long he says he read in the magazine Modern Healthcare that if his system is to be successful under health reform he needs to create an ACO. He has in mind forming a new organization called an ACO with a board that meets monthly. The help desk person says the matter is more complicated than that.

To see the full clip, which is funny and spot on, go to


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