Personalized health records promote horizontal integration within ACOs

ACOs, or Accountable Care Organizations, continue to be a hot discussion topic in health care reform. In the current issue of JAMA, Duke’s own Barak Richman and Kevin Schulman provide a unique business perspective on the implementation of ACOs. One of the issues they raise is the potential for the establishment of ACOs to result in health care system monopolies. They warn that health care systems might align under the promise of market dominance and not necessarily with the intention of improving health care quality or efficiency. In order to prevent a misaligning of goals, they urge that evaluation of ACOs should maintain focus on health care quality and efficiency.

Another recommendation they suggest is for health care systems to align under a horizontal vs. vertical or “bricks and mortar” approach. Whereas vertical networks focus on established hospitals and other infrastructure, horizontal networks would connect more fluid, geographically diverse care specialists. To me it seems like this idea mirrors themes in social and professional networking. Horizontal networks may take less time, investment, and have the potential to spread much more quickly than conventional geographically constrained networks. However, in my opinion a key challenge to the horizontal vs. vertical approach is how seemingly unconnected groups will be able to share information and provide coordinated care. I think that a potential solution would be the establishment of personalized health care records. Electronic personalized health care records would follow the patients, contain all their health care information, including their personalized health plan, and provide a virtual medical home that could provide a universal medium for exchanging health care information among horizontally connected providers. Without a universal medium to maintain coordination of care and ensure that information is efficiency conveyed, it may be difficult to envision how horizontal networks could provide cohesive care. In an ongoing era of rapid technology development, a personalized health care record would provide a potential means of increased portability and exploration of new options for new health care delivery models.

Health Affairs Special Issue on ACOs

This month’s issue of the health care journal Health Affairs was a special issue dedicated to the discussion of Accountable Care Organizations, also known as ACOs. The issue describes a number of exciting changes in approaches to health care being explored using ACOs. ACOs are organizations that provide care for a defined population. Under the new health care legislation pilot ACOs must provide universal care for a population of no less than 5,000 Medicare beneficiaries. The idea is akin to a large scale version of capitation. Instead of getting paid a set rate per patient, an organization gets paid for performing capitated care in bulk, providing all the health care needs for an entire community. The benefit of such a structure is that it creates the potential for novel, community-based interventions to save costs.
ACOs provide an exciting, rational reimbursement structure that would provide powerful incentives for decreasing costs through better care. If all patients within an ACO had electronic, perspective health care medical records, the community could potentially track not only health care needs of individuals, but could also identify health care needs of an entire community. For examples if a large number of patients were finding it difficult to find the time to exercise at work or were decreasing in cognitive decline due to a lack of social interaction, the ACO could use this information to intelligently guide community innovation that would benefit individuals on a large scale and result in further cost savings, improved health, and perhaps even quality of how the elderly live their lives.