The Problem

Escalating Health Care Costs

Individuals, families and employers are grappling with the problem of continuously escalating health care costs. According to the Kaiser Family Foundation, 75 percent of these costs are driven by the effects of treating chronic diseases, such as diabetes, heart disease, obesity and asthma.
Current models of care, including large PPO networks that offer insurer-based disease management and utilization management programs, have not proven effective in impacting continuously rising costs.

The nationally recognized Kaiser Family Foundation also shows that health care costs in the greater Houston area have more than doubled since 1999. As a result, an increasing number of individuals and families are priced out of health care coverage. Small businesses, which employ the majority of workers in the United States, have been especially hard hit by the escalating costs of health coverage. In 2000, 68 percent of small to mid-size businesses (3-199 employees) offered health benefits, but in 2009 that figure fell to 62 percent.

One Solution: Accountable Care Organizations (ACOs)

An Accountable Care Organization, or ACO, is a coordinated health care system that strives to deliver quality care at a lower total medical cost by focusing on several key areas:

• Coordination of care across multiple medical specialties and care settings, both inpatient and outpatient.
• Evidence-based care practices.
• Use of information technology.
• Quality measurement and accountability for quality of care, patient satisfaction and the total cost of care.
• Incentives for prevention, care management and outcomes.

ACOs practice team-based care in which physicians, nurses and specialists work together to provide coordinated care for patients. These professionals come together and agree on ways to improve care outcomes. A strong emphasis is placed on proactive measures, including prevention, identification of disease, and ongoing intervention on disease states.

How long has the Accountable Care Organization model been utilized?

The ACO model has been practiced for decades with a proven track record of success. Kelsey-Seybold Clinic was founded more than 60 years ago on the premise of physician-led, accountable care. Information technology has enabled a new level of accountable care and coordination to be provided for patients through Kelsey-Seybold’s Electronic Medical Record (EMR) system.

Are there other institutions that follow an ACO model?

Some of the leading health care organizations in the United States are Accountable Care Organizations. These include Mayo Clinic, Cleveland Clinic, Kaiser Permanente, Scott & White Healthcare and Geisinger Clinic.

What does ‘evidence-based care’ mean?

In layman’s terms, if a particular treatment addresses the patient’s need, and there is medical evidence or a consensus of experts indicating that it helps the patient, then the physician performs the treatment.

If there is no preponderance of evidence or agreement by medical experts that a particular treatment will help a patient, then it is not performed. Testing, hospitalizations and surgeries which do not add value, according to available medical evidence, are eliminated. Adherence to the guidelines of evidence-based care can result in quality health outcomes over time, and a total lower cost of medical care.