Healthcare USA* - Finance and the need for peripheral vision!

I came across this item on twitter c/o Gregg Masters - many thanks Gregg.

2011 Benchmarks in Accountable Care Organizations: Metrics from Early ACO Adopter

A key part of this is the chart below - which is copied below:

New Chart: Top 5 Challenges of ACO Creation

SUMMARY: Accountable care organizations (ACOs) create integrated delivery systems that encourage teams of physicians, hospitals and other providers to collaboratively coordinate care for ACO members. We wanted to see the biggest challenges organizations face in creating an ACO.

I keep coming up against and apologising for the fact of geography that puts me on the UK side of the Atlantic (it's the place I call 'home'), the NHS 'market' and the different ways health care is debated and framed with respect to finance. Basically 'P'rivate medicine and 'S'ocial medicine.

My perspective is limited, but the same applies to many people whether East, West, Private or Social and of course in reality things are never that cut and dried.

The reason I've picked this up though is three-fold:

Firstly, this post was found in the summary above and is wrapped up in the three words - integrated, collaboratively and coordinated - icc. Looks like we've got an ACO alright.

It is A Complex Organization.

The clue to the publication and survey is clearly vested in 'accountable', but in terms if icc where and with whom does accountability rest? No doubt accountability can - and must - be defined financially. What about the 'C'? When we think about 'care' - integration, collaboration and coordination there is a need to acknowledge and for me - reach out across the [h2cm's] humanistic axis.

Secondly, the graph 'speaks' volumes, but I wonder what I'm missing in not having the full copy? I wonder where the real human *care* factors are in this? If my colour vision is correct it would be worth checking the exact make-up of the 18% 'Other'.

Thirdly, I have a problem I admit. Residing in the UK working in the cocoon (and not so cosy at the moment) that is social medicine I see the US health care sector as a Matrix-like green ;-) haze of falling and tripping dollar signs - $$$ $$$. I know that's unfair as the N & S American continents are of course also fueled by those positives that charge and motivate health care workers the world over. In the chart though even when 'staff' are mentioned it's in terms of 'buy-in'. Yes it may be a cheap shot, but I'm versed in some dialects of consultancy speak...

There could be an account of the individual, nursing care, the therapeutic relationship, the quality of outcomes ... in the evidence-based care contribution 8%, but these days the search for evidence is fiscal too.

I just wonder here what might be lost in achieving integrated, collaborative and coordinated care if the people - the extended team - are lost amid the finance? Sometimes to see we need to rely on peripheral vision too. In fact it's a bit like looking down a telescope to 'see' you have to look off-center. If financial accountability is what colours your health care world, don't forget to avert your vision and take in the black and the white.

With no prospect of a 'study tour' (a scratch of the surface) there is much I need to learn of the organizational systems, commissioning and finance of health - not just in the USA, but here in the UK.

*These issues apply globally.