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| Olga Ramirez | Дата: Понедельник, 08.04.2013, 00:48 | Сообщение # 76 |
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| Kathleen LoBiondo | Дата: Понедельник, 08.04.2013, 06:09 | Сообщение # 77 |
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| Associated Press President Obama signs the Affordable Care Act at the White House, March 2010. The second mistaken assumption is that ACOs can succeed without changing patient behavior. In reality, quality-of-care improvements are possible only with increased patient engagement. Managed care, as formulated in the 1990s by the HMO model, left consumers with a bad taste because the HMOs acted as visible gatekeepers to patient access to care. ACOs, seemingly wary of stirring a similar backlash, allow Medicare patients to obtain care anywhere they choose, but there is no preferential pricing, discounting or other way for ACOs to steer patients to the most effective providers.The Everett Clinic in Washington state has taken steps to plug this hole by deciding not to become a full-fledged ACO. Last year, the clinic told patients that to remain with Everett, they must shift to Medicare Advantage鈥攚hich encourages preventive care and supports disease-management programs. 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But slowing the rise of health-care costs can't address the challenge of adding 50 million uninsured to the system while keeping expenditures the same or even somewhat lower than the unsustainable percentage of national wealth that they already represent. No dent in costs is possible until the structure of health care is fundamentally changed. How can that level of change be achieved? We beseech policy makers in Washington to study a range of reform approaches that aren't burdened by as many untenable assumptions as Accountable Care Organizations, and go well beyond them in their aspirations. 鈥?Consider opportunities to shift more care to less-expensive venues, including, for example, "Minute Clinics" where nurse practitioners can deliver excellent care and do limited prescribing. 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These include home care with patient self-monitoring of blood pressure and other indexes, and far more widespread use of "telehealth," where, for example, photos of a skin condition could be uploaded to a physician. Some leading U.S. hospitals have created such outreach tools that let them deliver care to Europe. Yet they can't offer this same benefit in adjacent states because of U.S. regulation.These and other innovative approaches have potentially large payoffs in how health care is delivered and what it will cost. By contrast, Accountable Care Organizations over the long haul may ease the path to slightly lower reimbursements or redistribute physician compensation among specialties. But what ACOs most assuredly will not do is deliver the disruptive innovation that the U.S. health-care system urgently needs. Mr. Christensen is a professor of business administration at Harvard Business School and co-founder of Innosight Institute, a think tank focusing on disruptive innovation. Dr. Flier is dean of the faculty of medicine at Harvard University and professor of medicine at Harvard Medical School. Ms. Vijayaraghavan is a senior research fellow at Innosight Institute. A version of this article appeared February 19, 2013, on pa http://longchamp-lepliageoutlet.webs.com - Longchamp outlet ge A15 in the U.S. edition of The Wall Street Journal, with the headline: The Coming Failure of 'Accountable Care'.
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| rootfqak | Дата: Вторник, 09.04.2013, 18:52 | Сообщение # 79 |
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