Accountable Care and the Transformation of Health Care in America

by Don Antonucci, President, Regence BlueShield

The ways in which health care is delivered and funded is undergoing evolutionary change, as a result of reforms put in place by the Affordable Care Act (ACA), and more broadly in response to the ever-increasing cost and complexity of health care in this country. As part of this shift, health insurers, health care providers, employers and individuals are all taking on shared responsibility for ensuring quality, affordable care is available to everyone.

At the core of this movement is the fundamental obligation to create a more effective and affordable system that not only treats illness, but promotes wellness. The best way to deliver cost-efficient care is by keeping people well, and by ensuring that the medical care they receive is safe and effective

Accountable Care is the term that describes a variety of arrangements that include incentives to providers for delivering quality care, and in which a patient’s care is coordinated through a close relationship with a physician or other health care provider in order to achieve the best possible health outcomes. 

Regence has put in place a number of Total Cost of Care (TCC) arrangements with provider groups throughout the state of Washington which incent doctors and hospitals to provide effective, efficient care by reimbursing them for quality outcomes rather than by individual services provided. These contracts are the first step in creating accountable health networks, and new health benefit products that will help keep patients healthy and premiums affordable.

Patients play a key role in the accountable care partnership. Under these arrangements, they will be called upon to take a more active role in their own health and wellness, and to make a number of decisions about their care, including in many cases, selecting a primary care physician or network. Health plans are able to provide the information and tools they will need to make these important choices.

While the health care system won’t be transformed overnight, change is occurring, and accelerating. Early results from pilot programs show that collaborative care is successful. The future of health care in the United States is being shaped by this collaborative approach to health care.