ACO (ACCOUNTABLE CARE ORGANIZATION
• Created by Obama Government under the Affordable Care Act • Doctors’ offices, hospitals and long-term care facilities working voluntarily together to treat an individual patient across multiple care settings with high coordination and quality.
• Objective: give the most cost effective treatment at the right time in the most suitable place, so as to reduce services’ duplication and clinical errors
• Facilitate coordination and cooperation
• A single, “bundled” payment covers services delivered by two or more providers during a single episode of care or over a specific period of time.
• Excellent results in the US: generally, they obtain between between 3 and 10 % of savings.
• The doctors are a key element in the success of such projects
• They have to be incentivized in a good way: to be only a doctor curing patients, not to be motivated by volumes.
• The new profile of doctor has to include: something about IT, economic management, clinical management etc.
• In our individualist society, if you want somebody to do something, you have to reward his effort by something.
• The United States have understood that and they give a percentage of the savings made in the integrated model to the professionals who have met their quality objectives.
• The health providers that have good quality results also get a shared savings and the Government, the initial financier of the project keeps a percentage to get his inversion back and re-invest it.
The model we implement place the patient at the heart of the system, not only in the use of resources but also in the evaluation. The American “patient-centered medical home” – or PCMH –, led and dynamized by the doctor and around whom is built an integrated team to look after patients.
It is not only about treating symptoms, but also understanding deeply the patient in his focusing on the patient in his/her entireness (psyche, soma, social environment; individual, family, collective; protection, promotion, food etc), with his emotions and expectations. All this process requires the adaptation/mutation of the doctor’s role.
It is also about strengthening patient’s empowerment, both with an pedagogic accompaniment enabling patients to understand why ITC really will benefit to him, will make his life easier, and through the implementation of tools/platforms enabling patients to become responsible for their care, to actively participate in the improvement of his own assistance.
Last, but not least, the evaluation has to be patient-centered too, taking into account his experience all way through the clinical pathway. That is what is promoted in the United States through the Patient-Centered Outcomes Research movement.