Accountable Care Organizations: Ensuring Focus on Cardiovascular Health.

Abstract

Although unparalleled in the provision of intensive lifesaving treatments, US health care has only begun to focus on other important aspects of population health. To achieve the triple aim of better health, better care, and lower costs, payment and delivery systems must evolve. The accountable care movement is central to this evolution, and engagement by cardiovascular specialists can help to shape it. Sustained partnering with policy makers could improve patient care by appropriately directing cardiovascular medicine resources and avoiding unintended harm to well-functioning systems of care. Accountable care organizations (ACOs) are part of a new payment and delivery model that aims to improve quality of care while controlling costs for populations of patients.1,2 ACOs took conceptual shape ≈10 years ago as an approach to achieve these goals in a manner that fosters flexibility.3,4 Unlike the managed care movement in the 1990s, capitated payments have not been a foundational element of the ACO movement (although components of capitation will likely prove important5). ACOs were therefore less disruptive to the status quo ante, and, with inclusion in the Affordable Care Act of 2010, they gained considerable momentum. Although Medicare has specific requirements for ACO structure and patient attribution, state and private insurers have engaged in a variety of alternative ACO models that could drive innovation. Within ACOs, providers can be configured in a number of ways ranging from physician-led groups and integrated delivery systems to hospital-based systems coupled with independent practice associations.2–4,6 The adoption of electronic health records has been an important feature that allows ACOs to measure and integrate care for populations of patients. Regardless of structure, it is widely accepted that ACOs should (1) be provider led and accountable for the entire continuum of care for a population; …