Nearly nine of 10 leaders in healthcare and healthcare policy think that the lack of incentives and current financial interests of providers and other stakeholders are barriers to moving healthcare toward more integrated and accountable delivery models. The latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey asked leaders their views on barriers to delivery system innovation and strategies for fostering more accountability and coordination among healthcare providers.
Healthcare leaders pointed out obstacles to the growth of accountable care organizations (ACOs), but were also quick to identify potential solutions. Large majorities support providing special payment arrangement to ACOs (65 percent) and giving providers financial incentives to practice in ACOs (65 percent) — similar to provisions in the Patient Protection and Affordable Care Act. ACOs are provider-led healthcare systems that are accountable for patient health outcomes and coordinate healthcare across providers and settings. ACOs can take on many forms, including tightly integrated systems like Kaiser Permanente, with hospitals and physician group practices all under the same umbrella, and physician group practices like those that took part in the five-year Medicare physician group practice demonstration.
Majorities of leaders support the growth of more integrated models of care delivery, like ACOs and integrated delivery systems, but also voiced concerns. Nearly three-quarters (74 percent) of opinion leaders said they were concerned or very concerned with providers acquiring excessive market power and dominance. To safeguard against such undue market share, a majority of healthcare leaders (56 percent) support regulation of ACO payment rates in regions with insufficient market competition — similar to the way a public utility is regulated. To alleviate concerns that accountable models of care would encourage providers to withhold appropriate care, more than eight of 10 leaders support the development of performance metrics for ACOs, as well as increased transparency and public reporting on quality of care, resource use and costs.
Other findings from the survey include:
- Sixty-three percent of opinion leaders support or strongly support development of a national accreditation system for ACOs.
- Nearly eight of 10 leaders (77 percent) support or strongly support establishing standards for primary care capacity as a condition of qualifying for payment as an ACO.
- Most healthcare opinion leaders (62 percent) support exempting ACOs from antitrust and other legal barriers to coordinating care and sharing cost information in exchange for meeting performance, disclosure and accreditation standards, with support particularly high among leaders in healthcare delivery (80 percent).
Source: The Commonwealth Fund, July 26, 2010
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