NYT Article On ACOs Replacing Health Insurers

I think it’s a bold (maybe foolish) prediction that is made in the NY Times article saying that ACOs (Accountable Care Organizations) will be the end of health insurers.  We don’t even know that ACOs will work yet.  You can even see some debate on this topic in this blog post on Why ACOs Won’t Work.

But, I’m not an ACO expert so let me focus on what I found interesting in the NYT article.  It points out a few things:

  1. The focus on preventative care
  2. The fact that some managed care organizations are changing (and others will too)
  3. The fact that “ACOs” (in whatever form they take) will need a platform

This is what I find interesting.

I think the concept of an ACO (or Patient Centered Medical Home) where care becomes localized and there is greater focus on prevention and wellness not just sick-care is great.  We should all want that to happen in some form.

But, in all cases, this changes the data needs and role of the physician.  They need to be empowered with new information and tools.  How do they manage their panel of diabetics?  Will some database track them and monitor their screenings and blood sugar?

When the field of medicine is constantly changing with new drugs and new studies, how will physicians have the best practices pulled into their practice?  They won’t want to wait the 16 years it takes for things to work their way through the system.  They’ll actually want to embrace the best solutions and see more comparative effectiveness information.

I see a huge opportunity here for someone to create an ACO “platform” that embeds business rules, tele-monitoring, consumer engagement, and reporting into a way to create the “i-physician” (informed physician) of the future.

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2 Responses to “NYT Article On ACOs Replacing Health Insurers”

  1. This is a good perspective on the ACO situation. Note that it is PBM technology (not the existing traditional PBM business model) and the pharmacist that could fill the opportunity to create an ACO “platform” that embeds business rules, tele-monitoring, consumer engagement, and reporting into a way to create the “I-physician” (informed physician) of the future. Pharmacy CLIA labs, pharmacist as physician extenders and pharmacist as the communicator with the patient (familar pathway to health) all coordinated through a pharmacist “provider” network.

  2. Wait, you mean to tell me that the New York Times published a cheerleading article about the PPACA, in an election year? Wow, that’s so surprising.

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