Medical Home vs. Accountable Care Organization

The following is a guest article from Bo Gamble, Director of Strategic Practice Initiatives with Community Oncology Alliance (COA). The medical home/ACO topic is a hot one that often generates more questions than answers. Bo shares his insights into the differences between the medical home and accountable care organization (ACO) models, including the risks and benefits of each.

Medical Home Ingredients – All Good Things

accountable care organization
Image source: ACO Summit

This past year seems to have included every letter of the alphabet soup of changes and challenges, from ACO, ASP, CMS, FDA, GPCI, NCCN, PCMH, SGR and all of the other acronyms in between.  It seems like we can’t get through even a few sentences before spewing out one of the alphabetized words. And yet, two of these concepts seem to have withstood the test of time – ACOs and PCMH.  Does this mean that they both have staying power?  Let’s explore………………

ACO’s are Accountable Care Organizations.  When the final rule of this HHS (ooops – we forgot one – Health & Human Services) concept came out in May 2011, there was a mad dash to see if cancer “care” was incorporated into this final version, since it was not addressed in the proposed rule.  The cancer community apparently noticed the glaring omission and shared the following commentary.

*The word “cancer” was mentioned in the proposed rule even more frequently than it was in the final rule.  Most of the mentions in the final rule were in reference to the comments stemming from the proposed version, and the majority of those were in the context of screenings.  There was not a single quality measure for cancer care in the preliminary or final ACO rules.  This seems to indicate that cancer care, in general, is not readily understood by policy makers; for if this concept had been truly grasped, the criteria with which to measure the efficient and high quality delivery of such care would have likewise been addressed. In that the treatment of cancer is, in fact, one of the top five most expensive health care conditions, this void or omission speaks to the lack of understanding.

* Bigger is not necessarily Better – One would think that if a larger, more consolidated regional healthcare delivery system were able to deliver a higher quality, more efficient model of cancer care, they would have done so.  Several recent studies have indicated that private, more community oriented, cancer care is less expensive to both payers and patients.  Some would argue the point that patient and family satisfaction is also higher in the community setting.

* Risk versus Benefit – The whole concept behind an ACO model is participant sharing of the collective (supposed) savings that would be realized after years 1, 2 or 3 of participation. However, in order to participate in this potential profit, a provider may be asked to forfeit their culture and identity and become part of a larger organization that could possibly move at the pace of country molasses on a cold winter day.  Many providers do not view this potential benefit worthy of the risk and autonomy they may lose – particularly as it relates to cancer care.

* Us versus Us – Probably the largest drawback to an ACO model is the fact that it pits this integrated delivery system against itself with regard to savings.  So then, this model actually morphs a care organization into a new payment model that has the potential to actually minimize capital investments into the delivery model.  After all, capital investments could translate into lost savings, particularly when the return on investment extends to any multiplier of 3 years.

The alternative to the ACO is the Medical Home.  This model has built in incentives that create value for all stakeholders in real time.  A brief description follows:

* All good things – The oncology medical home is the home for all good things, whether it be unique and different payment models that recognize or reward quality, value, and efficiency, or simply tools and technologies that enhance the patient and family experience.  If it is good and helps promote quality, value or efficiency – it belongs under the umbrella of a medical home.

* Led by Stakeholders – The Oncology Medical Home model is steered by representative stakeholders for the mutual benefit of all cancer care stakeholders.  These stakeholders include: patients, providers, payers, communities, employers and patient advocacy organizations.  One of the core beliefs of the oncology medical home is that all will benefit if the components of quality, value and efficiency are emphasized, promoted and recognized.

* Support Network – Stakeholders drive the decision-making process of standardizing measures and recognition.  However, a talented peer group within the cancer care community will help to identify, endorse and implement the tools, templates and technologies that will assist teams in achieving their maximum quality, value, efficiency, and ultimately reward, with minimal financial or administrative burden.

* Us versus Them – In order to demonstrate quality, value or efficiency within this model there must be:

a) A standard set of measures

b) Automation to produce these measures without administrative burden

c) A repository to compare yourself against the peers not only in your specialty but other specialties.

This ongoing competition to continually improve while being rewarded for achieving improvements gives this model staying power, while at the same time, driving down costs and eliminating inefficiencies.

The Medical Home Model is a process that invites and encourages innovation in all things; patient-oriented workflows, integrated and coordinated care, a variety of reimbursement models, and an enhanced identity by the provider team.  This innovation, with an emphasis on demonstrated achievement, creates a place of comfort and care; a place that any cancer patient would want to call home – a place for all good things.

Bo Gamble has been involved in healthcare for over 30 years, and the last 13 years in cancer care. He has a passion for all good things in cancer care.

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