P4P, PCMH, ACO…The Concept Is The Same

Healthcare is very good at creating TLAs (Three Letter Acroynms). The Accountable Care Organization (ACO) and the adjacent models are no different.

You have:

• Accountable Care Organizations (ACOs)
• Patient Centered Medical Homes (PCMHs)
• Pay-for-performance (P4P) models
• Health Home (HH) for Medicaid

These are of course governed by:

• Center for Medicare and Medicaid Services (CMS)
• Health and Human Services (HHS)
• National Committee on Quality Assurance (NCQA) has an accreditation for ACOs

And, they were significantly impacted by the SCOTUS (Supreme Court of the United States) decision regarding PPACA (Patient Protection and Affordability Care Act).

But, at the end of the day, the goal here is the same. We need a solution that addresses:

• Cost, Quality, Care (the Triple Aim)
• Our existing infrastructure
• Our unique healthcare environment in the US
• The challenges of changing patient behavior

We all know that the healthcare system is not sustainable without change. What will happen to health reform with the election is still TBD, but at the end of the day, change is needed. PPACA might not be perfect, but it was better than a lot of options (IMHO). As I said before, I would focus on phased change:

• Improve access for all Americans
• Build out connectivity and technology
• Develop a new payment model
• Integrate payment with outcomes