Monday, May 23, 2011

Wellness in the ACO Ecosystem

An ACO, or Accountable Care Organization, is a new model of coordinated healthcare allowed by the Affordable Care Act (aka health reform). In short, ACOs are one way doctors, hospitals and other healthcare providers can work together to better coordinate care for their patients. From the patient perspective, the goal of an ACO is to eliminate the frustration and hassle that comes with disconnected care. Each of us has some experience with this frustration and having a more user-friendly healthcare experience is welcome.

The goal of the ACO is to improve patient health (called "outcomes" in the healthcare system), improve the quality of care and lower costs. Impressive goals. And, in my opinion, possible if the ACO includes a comprehensive wellness solution within their program.

A comprehensive wellness solution is not to be confused with the old tems of "case management" or "care coordination" or "disease management." Each of those programs did deliver some savings and did improve some patient outcomes. They did not, however, put enough focus on the "whole person." An ACO modeled on the old ideas of disease management is less likely to succeed. Wellness is whole-person centric and is not about whichever diagnosis label appears on the medical record.

None of us are simple, one dimensional beings and our healthcare treatments cannot be one dimensional. We know lifestyle choices cause most diseases (heart disease, stroke, diabetes). When a doctor sees a diabetic patient, the doctor isn't treating "the diabetes" he is treating a person whose lab reports show a high level of sugar in the blood. The reasons for the numbers on the lab report are likely complex and a good outcome requires a whole-person strategy that combines medical, social, cultural and educational components.

Therein lies the challenge for the ACO. An ACO comprised of even the best team of clinicians will miss the opportunity for true improvement in "person health" if they treat based on historical practice and a disease-focused, patient-centric approach. "Person health" improvements demand a comprehensive wellness program focused on the whole person including exercise, nutrition and wellbeing.

A few ideas to consider:

I want to see ACOs succeed because I want people to be more healthy and happy.  Lifestyle choices are eating the healthcare system alive. An ACO lacking a lifestyle program is destined for mediocrity, at best. If you are working on an ACO design, consider comprehensive whole-life, person-centric programs in your design. It matters.

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