AMGA believes that our current system of health care delivery does not adequately hold providers accountable for the care they provide, nor for providing the full spectrum of care. Creating accountability is impossible until we transform the current volume-based system into one that pays providers based on outcomes (quality) and value (efficiency). Once a link has been made between compensation and results, provider accountability will grow. To promote accountability, and build on existing medical practice patterns, Congress has taken an important step in the creation of accountable care organizations (ACOs) in health reform law.
Principle I (Guiding Principle): Multispecialty
Medical Groups and Other Organized Systems of Care Make the Strongest
Foundation for ACOs
AMGA believes multispecialty medical groups and other organized systems of care should be the foundation of any ACO. Multispecialty medical groups are more likely to invest in health information technology, form teams of providers, collect and analyze data, and provide direct physician feedback on clinical care. Studies suggest that multispecialty medical groups are more likely to use care management processes and may use fewer resources than other modes of health care delivery. Evidence shows there is greater collaboration among physician specialties and allied health professionals in large, multispecialty medical groups. The key components of care coordination, team-based care, and accountability for the patient care provided form the foundation for successful ACOs and are the backbone of multispecialty medical groups and other organized systems of care.
Principle II: ACOs Must be Physician-Led
Physicians are the medical professionals best qualified by training, education, and experience to provide diagnosis and treatment of patients. As such, they are the core component of medical care delivery. The strongest underpinning of a true ACO is the physician-directed, multispecialty medical group or other organized system of care. Physician-led multispecialty medical groups, integrated delivery systems, and physician-led organized systems of care already function as ACOs. These ACOs have demonstrated their ability to be the most effective and efficient vehicle for providing the highest quality of medical services to Americans.
Principle III: Accountability for Health Care
AMGA defines an ACO as a physician-led, patient-centric entity that has invested in the necessary infrastructure to measure, assess, and advance the effectiveness and efficiency of patient care. The ACO should provide integrated, team-based, coordinated health care services across provider specialties and settings. It is willing to be held accountable for clinical results and cost efficiencies in the communities served. ACOs may be integrated actually or "virtually" with other providers to offer the scope of needed services for patients.
Principle IV: ACO Incentives Must Be Aligned to
Foster Voluntary Participation
In order to create real delivery system change, ACO rewards (opportunities for shared savings or partial capitation) must be aligned with the participation risks (start-up costs, systems investments, "culture" changes, and financial uncertainty). ACOs agree to be accountable to their patients on both the quality and efficiency spectrum. Developing this capacity is costly, labor intensive, disruptive, and uncertain. Payment methodologies commensurate to these factors must be made available to encourage ACO development.
Principle V: ACOs Must Have a Primary Care Core
To function as a comprehensive source of patient care, foster true care coordination, provide the framework for patient-centered care, and achieve optimal results, an ACO should be anchored by a core of primary care physicians and services appropriate and adequate to meet the needs of the community population it serves.
Principle VI: ACOs Should Be "Learning Organizations"
Inherent in the ACO concept is the idea that internally produced data and feedback should be used to standardize care processes and continually improve performance. Standardized care processes reduce unwanted variation in the practice of medicine, making it easier for physicians and other members of the health care team to do "the right thing" on a consistent basis in meeting the needs of their patients. "Learning organizations" are health care organizations that gather and use data to improve the efficiency and safety of patient care. As the lessons learned in one ACO may be scalable and transferable, that information should be communicated, on a voluntary basis, with others interested in improving quality and efficiency of health care delivery.
Principle VII: ACO Core Values and Attributes
An ACO is an organization that provides a coordinated continuum of health care services and is willing to be held accountable for the quality and efficiency of the health care provided to the ACO's community. An ACO subscribes to the core values and demonstrates attributes enumerated:
Core Values of Accountable Care Organizations
Adopted May 28, 2010