A lot of people are talking about accountable care as a cost-control experiment. That assertion misses the Triple Aim of accountable care: cost, quality, and satisfaction. Further, satisfaction must include both the provider and recipient of health care services. Focusing on just patient satisfaction is a fool’s errand if we don’t improve the job satisfaction of medical professionals. We all agree that the $2.6 trillion we spend on health care each year in the United States is not sustainable. The balance sheet of our country is broken and health care is a huge contributor. To truly transform it, participants in health care need to observe the performance of other industries that achieve lofty levels of product and service quality, high customer satisfaction and continuous efficiency gains.
Think about your favorite communication device. Do you think a day goes by where the manufacturer of that device thinks only about the quality of its product, but little about what its customers say? Or the cost-effectiveness of producing the device while allowing someone else to dictate its price? Of course not — but that is what has happened to health care. In today’s fee-for-service model, we have over time eliminated or weakened accountability for quality and economic outcomes, while creating a limitless demand for as much health care service that someone else’s money can buy.
Accountable care is not a cost-control experiment. We can’t take cost out of the system by just trying to drive down unit costs, shifting risk to providers without the information to manage that risk, or restricting patients’ access to care. Unit price controls and utilization management were the hallmarks of the early versions of managed care. The industry tried it. It didn’t work. You get more units and limiting services without understanding clinical outcomes defers and exacerbates long term costs.
Accountable care is about getting health care right; striking the right balance of cost, quality, and satisfaction. It’s about creating a new paradigm that enables value-driven decisions, supported by the right infrastructure; comprehensive technology solutions and support; patient-centric programs and services; and appropriate incentives to deliver a high-quality, cost-effective product to a population of thousands or a population of one.