What is accountable care all about? And who should be held accountable, anyway? Are physicians directly responsible for the outcomes they achieve? What about the money they spend to achieve those outcomes?

We’ve all been hearing about the pros and cons of accountable care for way too long now. Lower costs, better outcomes and improved patient experiences are what it apparently seems to be about. However, I believe we can do better than this.

Physicians are assessed on their output rather than outcomes. It is fair on their part to be more interested in performing more procedures and seeing more patients – one of the reasons why the pay-for-value model is being advocated as the way forward is to reduce the cost of healthcare.

This may look good for providers, but how are patients being included in the process? What incentives are being offered for them to be involved in the care process? Are their hospital visits being reduced? Are they getting any discounts on their medical bills? I don’t think so.

Accountable care is being promoted as a model in which, physicians “assume risk”. But then everything in life can be  risky. Will I fall sick or get injured this week? Will I be able to recover in time for my next conference in Florida? Which physician would I need to consult and how much would it cost me?

Due to such concerns, I would transfer some of my real life risks to an insurance company, which for a nominal monthly fee, agrees to pay my medical bills in case I require medical treatment. On the other hand, the insurance companies also want to retain substantial revenue in order to provide more value for investors.

When doctors do a good job of providing efficient and effective care, while keeping patients healthy, insurance companies are able to retain more funds. In order to improve their value even further, they encourage patients to stay healthy by offering discounts for certain medical checkups and other benefits. On the flipside, they encourage providers by sharing the money saved as a result of their efficiency. But the question remains, how are providers really incentivizing patients to become more involved in their care delivery?

After having a long discussion on the topic with my physician friend Kenneth, I realized that in order to have a successful accountable care model, he will need to help patients avoid risk, help insurance companies manage risk and avoid taking a lot of risk himself.

Kenneth says in order to measure his patients’ risk; he needs to list all the high-risk problems. He thinks he will need to see patients suffering from hypertension, hyperlipidemia and diabetes. After that, he needs to enlist patients suffering from uncontrolled blood pressure, cholesterol and sugar. Together with this information, he will be able to focus his attention on high-risk patients.

He also believes that high-risk patients can be engaged in the process by effective use of office tools which allow shared decision-making and keep them in the loop through patient portals. These tools can also be used to send customized messages to specific populations  via targeted campaigns.

In addition, Kenneth’s trusted colleagues in his network can also be involved in the care coordination process. As the healthcare industry moves towards accountable care, groups of providers can be formed who are willing to work together after clearly defining the rules of business, commitment towards saving costs, increased data exchange and so on.

Together with all the available modern tools, physicians can analyze results where they can track every dime spent on delivering quality care. Through this analysis, some cost cutting measures can also be adopted.

This is what the future of healthcare industry is all about. It wouldn’t be too long before health IT tools become as important as a stethoscope for a physician.