State Is ‘Ready, Willing and Able’

The U.S. Health and Human Services agency yesterday released federal rules on accountable care organizations (ACOs). It’s a big step nationally for health care reform — and may be a significant development for California, given the current structure of doctors’ offices, hospitals and long-term care facilities in the state.

“This is a promising new day for seniors in California,” according to Donald Crane, President and CEO of the California Association of Physician Groups.  “Where accountable, coordinated care will be supplanting inefficient, costly fee-for-service.”

In health care policy circles, an ACO is often compared to a unicorn — everyone knows what it looks like, but no one has actually seen one.

“That’s just not so in California,” Crane said. “We know all about ACOs because we have ACOs already. We’ve got capitation, and that is the accountability for cost, and we have a longstanding pay-for-performance program, and that’s the accountability for quality. So we have the twin pillars for accountability right now.”

That means California is more likely than other states to move smoothly and quickly into ACOs, Crane said.

“We’re ready, willing and able, that’s the big difference,” he said. “We have proven, in many ways, the concept that you can bend the cost curve down and bend the quality curve up.”

The idea, he said, is to coordinate care, aided by mid-level practitioners such as physician assistants and nurse practitioners, which lowers cost overall and eliminates the gaps in care that occur because of the hand-offs and transitions between providers.

“California has been and will continue to be a leader,” Crane said, in the concepts of improving the continuum of care, particularly in managing the chronic conditions of seniors.

Crane speculated that the rest of the country will most likely take on contracted networks first, such as California’s independent physician associations (IPAs). “IPAs are relatively easy to develop,” he said. “They could be started up and developed fairly rapidly, in the space of a couple of years.”