Policy analysts see big ACO challenges

Hospitals and doctors may underestimate the complexity, cost and time required to establish successful accountable care organizations, a scenario that would set providers up to fail, two health policy experts argue in the Journal of the American Medical Association.

Stephen Shortell, dean of the University of California at Berkeley School of Public Health, and Sara Singer, a Harvard University assistant professor of health policy and management, said a “constellation of potential shortcomings” could leave newly formed accountable care organizations unable to improve health care quality.

Hospitals and doctors have limited experience managing care and costs for all the care patients' receive, regardless of the setting, the authors said. Healthcare information technology can vary from one provider to another and providers need time to adapt to newly adopted IT systems, the article continued.

Shortell and Singer said providers risk overestimating their ability to handle such substantial challenges, as well as others, such as performance reporting and reducing variation in medical care. That would compromise timely access to information. It could also undermine efforts to engage patients; develop needed contracts with specialists; avoid legal pitfalls; and change healthcare delivery to improve quality, the authors wrote.

To avoid such potential problems will require leadership across the public and private sector and well-developed performance measurement, the article said.