Achieving the Full Potential of ACOs

New England Journal of Medicine.

The success of accountable care organizations will depend mostly on whether or not they will be able to improve performance of providers, not operational issues that have been scrutinized over the last year, according to an article in the

Authors James Walker, M.D., and Aaron McKethan, Ph.D. write that unless an ACO can pay careful attention to the core competencies that will provide value to patients, an ACO won’t reach its full potential, regardless of how perfectly structured it is.

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he improvements that ACOs and other new care models aspire to achieve will require a clear vision of what optimal care looks like from the patient's perspective,” the authors write. “This vision must then be operationalized by patients and clinicians across the spectrum of care in the shared design of scores of patient-focused care processes, or plans of care for individual patients based on the best available evidence, patients' circumstances, and other factors.”

They write that care processes need to be convenient, efficient and reliable, as well as better managed than they usually are in the U.S.

While ACOs will provide value to improving the health system because it is a new approach the provider reimbursement, they won’t be able to achieve full potential unless attention is devoted to “developing the organizational an technological competencies” of those who use ACOs.

“Just as unprepared, out-of-shape athletes will not get very far even on the most advanced bicycles, care delivery organizations participating in payment-reform programs but not committing to the foundational capabilities for actually delivering accountable care will not achieve their full potential,” the authors write. “Advanced equipment and advanced skills are mutually reinforcing — and both are essential.”