Accountable Care Organizations and the Clinical Laboratory
The major elements of health care reform include:
- Improve access by health insurance reform
- Improve quality of care
- Reward for value instead of volume
- Reduce cost by eliminating unnecessary care
- Chronic care management versus episodic care
- Population management
Accountable care organizations (ACO) have been created to meet these goals of health care reform. In an ACO, physicians, health systems or both assume responsibility for the cost and quality of care for a specific population of patients. More than 300 Medicare and private ACOs are currently in existence providing coverage for more than 20 million patients.
Formation of an ACO requires fundamental structural, fiscal and cultural changes to be successful. Importantly, they must determine how to equitably distribute shared savings. If not set up correctly, ACOs have the potential to disrupt traditional relationships between primary care physicians and specialists.
The goal of an ACO is to coordinate care between providers and across episodes of care. Improved coordination of care should lead to improved quality of care, increased patient satisfaction, and lower medical costs. ACOs emphasize preventive health and management of chronic diseases. They strive to keep patients out of the hospital and decrease unnecessary resource utilization. If these benchmarks are met, ACO providers share in any financial savings that have accrued.
Formation of ACOs has many implications for the clinical laboratory. They must rapidly evolve to serve the many needs of patients and providers in an ACO. Clinical laboratories will need to provide services for the entire continuum of care from obstetrics and pediatrics to long-term care and hospice. Clinical laboratories must increase the footprint and hours of their patient service centers to enhance patient accessibility and convenience. Laboratories will need to offer rapid turnaround time and immediate access to lab test results to both patients and providers. They need to seamlessly provide test results throughout the health care system. Laboratory results will need to be available in many formats including electronic medical record, computer, smart phone, smart pad and the cloud. Longitudinal laboratory results need to be trended to detect changes in a patient’s medical status and support the entire continuum of care.
In the shared savings model of an ACO, laboratories must keep their cost per test as low as possible and make their lab fee schedule totally transparent. In a shared savings environment, physicians will choose the laboratory with lowest costs and highest quality. Testing needs to be standardized throughout all inpatient and outpatient settings to reduce the risk of misinterpretation of results and the duplication of laboratory orders.
Clinical pathologists must become actively involved in decreasing unnecessary test utilization and insuring that necessary tests are ordered. They need to become adept at mining big data to predict the risk of patient readmission to the hospital. Esoteric test results need to be consolidated into a single interpretive summary to improve patient care and decrease the risk of misinterpretation.
Many challenges must be met if laboratories are going to serve future health care models. If done correctly, successful laboratories will position themselves as an even more integral member of the health care team.
