There is a satirical video circulating on YouTube lampooning a clueless “health care executive” who has read in "Modern Healthcare" that he should set up an Accountable Care Organization (ACO) and “have lots of meetings” to make his board happy. When asked about his experience with care management, medical homes, multiply chronically ill patients, health coaches, etc., he just stares blankly. Elliot Fisher, MD, the Dartmouth health policy expert widely credited as one of the co-parents to the ACO concept, showed the video at the recent Beeson Scholars meeting as part of his keynote talk, and we tweeted it when we first saw it a few weeks ago.

What makes it bitterly funny is that we are all like that clueless executive. Although everyone interested in health care reform is hoping that ACOs will provide a miracle cure for our ailing health system, no one is really sure how they will work. ACOs are roughly defined in the Patient Protection and Affordable Care Act as “shared savings” organizations made up of locally cooperating physicians and hospitals as well as (maybe) other health care professionals and settings, which accept some responsibility for a defined population served by the primary care arm of the partnership. While Medicare fee-for-service billing would proceed as usual, the ACO stands to “share in the savings” if by its collective effort it is able to reduce overall Medicare spending on the identified population of patients and meet as yet undefined quality targets. In principle, the ACO brings to the wide world of fee-for-service, non-integrated health systems some of the same incentives that are thought to have made Kaiser, Mayo, and Geisinger so effective and efficient.

The only rub is that what these entities have done clinically that allows them to keep per capita spending down is very unclear. What do they do by way of primary care that keeps patients out of the hospital? What do they do in the hospital discharge process that reduces unplanned readmissions? What are the replicable clinical models of care that others might adopt to achieve similar cost and quality results? And will what they have done work on the multiply chronically ill older adults who are the real cost drivers in the health care system?

But several weeks ago, as if in answer to the YouTube video, Modern Healthcare published "Coaching with Care: Patient Advocates Help Guide Post Hospital Care in an Effort to Improve Outcomes, Reduce Readmissions" by Maureen McKinney in its Patient Safety section. The article focuses on readmission reduction as a low-hanging fruit of health care reform that will soon change from a money-loser to a source of profit for hospitals. Given that an astonishing 20% of Medicare beneficiaries hospitalized for medical conditions are readmitted to the hospital within 30 days and that half of those are readmitted without a follow-up visit to the doctor, there seems to be a lot of opportunity in the area. The article starts by talking about BU’s Project RED (Re-Engineered Discharge) funded by AHRQ and then discusses Eric Coleman’s Care Transitions Intervention and Mary Naylor’s Transitional Care Model.

We were very happy to see this piece. This kind of translation from the academic publishing world into the trade press is essential if we want to influence leaders in health care management, who will soon be making decisions as to how to implement pilots and demos under health care reform. We hope that they are giving careful consideration to these clinical models as well as those for improving primary care (IMPACT , Care Management Plus, Guided Care, hospital care (ACE and NICHE), home care (CHAMP), health promotion/prevention (NCOA’s evidence-based health management programs) and all the other sectors. There is also an excellent resource for overcoming the difficult organizational challenges in coordinating care across settings and time, created almost 20 years ago by the National Chronic Care Consortium: its Self-Assessment for System Integration.

We also enjoyed seeing in the Modern Healthcare article some of the great pictures taken by Don Battershall for past Hartford Foundation annual reports. Thanks, Don!