A recent article in the Wall Street Journal (WSJ registration required) describes how new partnerships of doctors and hospitals to improve outcomes and reduce cost have achieved mixed results. These new groups – accountable care organizations – have been formed to reward health care providers for making and keeping people healthy. It’s hard to argue with that.
The problem, according to the article and preliminary research on such ‘pay for performance’ approaches to medical care, is that to make people well or healthier, sometimes you have to spend money. Second (and this is the biggest problem with ACOs), the benefits that people gain by working more, being more independent, etc., are not factored in. The truth is cancer survivors have created over $127 billion in additional productivity.
How would the right measure be determined?
The goal is to spend as little money as you can to make people as healthy as you can. And it’s a great idea to pay doctors based on patient health rather than the number of procedures or tests they conduct.
Sometimes, however, seeing a patient more often can lead to better health over time. And sometimes a medicine or procedure that may cost more than standard care can produce long-term benefits and reduce spending in the long run. In fact, dollars spent discovering new medicines saves more than 7 times that amount from the costs of illness and ineffective treatments.
Where would the accountability be?
The central flaw with ACOs, from the perspective of cancer patients, is the fact that accountability is to a bottom line, not to a patient's well being.
An accountable cancer-care organization, for instance, would focus on identifying the driver mutations of a cancer, establishing the unique pattern and pathways a tumor takes as it grows, being aware of overall physical well-being, and respecting the wishes of patients and families. Finally, an accountable cancer-care organization would pay for the most transformative technologies and would not stick patients with the bill to meet a short-term budget goal. Within the year, accountable cancer care would see billions of dollars saved in medical expenses.
Would cancer patients actually be given a choice?
Today, patients are assigned to an ACO and have no say in the matter. Why not give people the option to go to those groups that deliver truly accountable cancer care? One way to do this would be to establish a report card and benchmarks that patients could use to see which health plans and ACOs are truly committed to personalized cancer care... Stay tuned!