10 Mistakes Accountable Care Organizations Still Make

Ken Terry             Informationweek             August 2011

A new article about Accountable Care Organizations (ACOs) in the Journal of the American Medical Association, two health policy experts reaffirm the importance of health IT, including electronic health records (EHRs), in building these organizations. Simultaneously, they indicate that the technology is not yet up to the task.

In the paper, Stephen Shortell and Sara Singer, UC Berkeley and Harvard Schools of Public Health respectively, offer a list of 10 mistakes that ACOs may make. They are:

1. Overestimation of ability to manage risk
2. Overestimation of ability to use EHRs
3. Overestimation of ability to report performance measures
4. Overestimation of ability to implement standardized care management protocols
5. Failure to balance the interests of hospitals, primary care physicians, and specialists in creating governance and management processes to adjudicate differences
6. Failure to sufficiently engage patients in self-care management and self-determination
7. Failure to make contractual relationships with the most cost-effective specialists
8. Failure to navigate the new regulatory and legal environment
9. Failure to integrate beyond the structural level
10. Failure to recognize the inter-dependencies and therefore the potential cumulative “race to the bottom” of the above mistakes

Shortell went on to comment about each of the possible mistakes ACOs are subject to making. In conclusion, Shortell indicated that almost no one in the country has the level of health IT sophistication and performance maturity, although Kaiser might be close.