How Would An Accountable Care Approach Change How A Patient is Treated?

ACOI’ve experienced healthcare delivery as a patient, a nurse and an organ donor coordinator. I’ve also experienced a different side of the healthcare delivery system by selling a variety of products and services. Like many people close to our healthcare system, I’ve become very aware that sometimes our system is the best in the world … and sometimes it is starkly apparent why it needs to improve.

That is why I’m so excited about accountable care. For the first time, technological capabilities, political incentives, and the economic landscape are coming together to create a perfect storm in which cost and quality improvements can be realized on a large-scale, sustainable basis.

A Healthcare Consumer’s Role in Accountable Care

It’s important to recognize that accountable care isn’t just a piece of legislation or a new organizational or payment structure. Nor is it just applying technological advances to make healthcare more efficient. It is a fundamental shift in making people accountable for how care is delivered and experienced. And it is founded in the shared responsibility we all have—patients, providers and payers—to make sure our healthcare dollars are used wisely and well.

All of us, no matter our role in the healthcare industry, are healthcare consumers. And there are plenty of opportunities for us to be more accountable both in taking care of our own health and making sure the system works well.

Healthcare Gaps Addressed by Accountable Care

Whether we’re aware of it or not, we likely have all experienced gaps in getting healthcare services that can be addressed by accountable care. These gaps can have a huge effect on our health, or they may just be incidents that add another straw on the back of our nation’s mounting healthcare costs.

Here is an example—from my own personal experience—of a healthcare episode of resource misallocation that could have been avoided by accountable care. It isn’t the most dramatic example I could share, but I think it illustrates well the problem the average consumer faces.

My general practitioner (GP) put me on a cholesterol drug that was known to have liver side effects. Sometime thereafter, his staff performed a liver profile study on me and discovered elevated liver enzymes in my blood. My GP suspected nonalcoholic fatty liver disease, a potentially serious condition that can progress to hepatitis and possible liver failure. He ordered a liver biopsy to confirm his diagnosis.

A liver biopsy is an invasive—and uncomfortable—procedure that costs thousands of dollars and has potentially serious side effects. I’m not someone who wants to take chances with a vital organ, but I’m also realistic. So I asked the nurse why we couldn’t just discontinue the cholesterol drug—which seemed to be the reasonable cause of my elevated liver enzymes—and then redo the liver profile to see if they were still elevated. The nurse’s response: “The doctor said we need to do the biopsy. He’s the doctor and you can always get another doctor.”

So I went through with the biopsy, and, as I had suspected, the results came back negative for liver disease. My doctor discontinued the cholesterol drug, and my enzymes went back to normal. The expensive procedure and the cholesterol drug were completely unnecessary.

Clearly, this isn’t a story where a gap in care resulted in significant harm. I neither lost a limb nor racked up a medical bill in the six figures. But I’m still dissatisfied with the decision to order the biopsy rather than taking the more conservative approach of discontinuing the suspected drug and then decide about the need for an invasive procedure. It is these kinds of decisions—this utilization of avoidable procedures—that contributes significantly to the cost of our healthcare today.

Making It Better with Accountable Care

How would my story have been different under accountable care? Much could be said about shared decision making that should have included me, my GP and his nurse in the decision to go forward with the biopsy. The great thing about accountable care is that it empowers everyone involved in care to make the best decisions to positively affect cost and quality.

In an accountable care world:

  • Everyone working at my GP’s practice would have had an incentive to avoid an unnecessary, high-cost procedure.
  • My doctor would have had evidence-based guidelines on hand to help guide his decision of whether or not the expensive biopsy was indicated.
  • My GP and his staff would have had an electronic medical record to help them track my lab tests over time, reconcile my medications and note trends.
  • My engagement as a patient would be more validated by the system.

I am excited to be part of Health Catalyst, an organization that gives healthcare providers the insights they need to make this accountable care process work. As our healthcare delivery model shifts from treatment to prevention, from episodes of care to continuity of care, analytics will be key. If we use analytics well to help providers and patients make the best possible decisions, the future of our healthcare delivery system will be very bright.

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