Measurement Will Be Key to ACOs' Success, Experts Say
<p>In crafting the Affordable Care Act, Congress assigned an important role to accountable care organizations (ACOs) in helping physicians, hospitals, and other providers work together more effectively to improve quality of care and slow health spending growth. In the new issue of the <em>Journal of the American Medical Association</em>, two leading proponents of ACOs contend that rigorous performance measurement and evaluation will be critical to the success of these organizations in achieving their goals.</p>
<p>In a <a href="/publications/journal-article/2010/oct/accountable-care-organizations-accountable-what-whom-and-how" target="_blank">commentary</a> written with Commonwealth Fund support, Elliot S. Fisher, M.D., and Stephen M. Shortell, Ph.D., argue that performance measures in health care are too narrowly focused on individual clinicians, rather than the systems of care in which they operate. An integral part of implementing ACOs, they say, will be measuring processes and outcomes across the care continuum to support improvement and accountability and reduce the administrative burden associated with performance measurement.</p>
<p>Fisher, who directs the Dartmouth Institute for Health Policy and Clinical Practice, and Shortell, dean of the School of Public Health at the University of California, Berkeley, envision how ACOs could use different measurement approaches depending on the capabilities of their health information technology systems. For example, ACOs that lack electronic health records (EHRs) could at first rely on measures gleaned from claims data, like cancer screening, and then later adopt measures of health outcomes and patient-reported care experiences. The most advanced ACOs—those that currently have EHRs across all sites of care—could measure informed patient choice and outcomes for an array of conditions. </p>
<p>The authors also call for a common framework for evaluating the range of delivery and payment reform initiatives in the Affordable Care Act to help determine which ACO characteristics are critical to their success. <br /></p>