In the age of rapidly shifting models regarding health and healthcare in the United States, Accountable Care Organizations are often cited as a practical example for how to solve the complex healthcare system and distill it down to the greatest care for the greatest number of patients.
To review, Accountable Care Organizations, or ACOs, are a healthcare model in which payers and providers collaborate to treat a specific patient population (1). ACOs may include value-based care initiatives, such as providing discounts or merits for reducing certain disease metrics, apply forward-thinking cost savings initiatives, and essentially aim to coordinate care across the patient population. While at first glance ACOs may seem geared towards primary care providers, in effect ACOs must include surgical and anesthesia providers in order to expand coordinated care to include tertiary and specialty care. Anesthesiologists and anesthesia providers may participate in an ACO by function of their dedicated health center, or they may also spearhead anesthesia specific models through what is known as Accountable Anesthesia Organizations, or AAOs. As the title suggests, these are anesthesia-specific ACO partnerships, led and managed by leaders in the field of anesthesia.
Given that ACOs have disseminated throughout the healthcare market for several years, it behooves healthcare leaders to analyze progress thus far, as well as areas for improvement moving forward. With this aim in mind, researchers from the University of Michigan’s Center for Healthcare Outcomes and Policy produced a longitudinal study that analyzed 10 years’ worth of data at the federal level (2). The aim of the study was to examine hospital and healthcare centers that are active participants in ACOs and elucidate whether these centers experienced a decrease in surgical spending. As surgical spending represents a significant portion of hospital global budgets, this metric was utilized as a proxy for evaluating trends on this topic. During analysis, variable such as hospital-specific patient segmentation, number of anesthesia and surgical staff, and other specificities were treated to control for potential skew.
In the end, the researchers found that participation in ACOs was not associated with a decrease in surgical spending. This effect extended to expenditures related to staffing, e.g. for anesthesia and surgical providers, post-acute care providers, etc., as well as to unit costs for patient length of stays and medications management. In an ancillary result, the study found an improvement in surgical outcomes for patients at ACO-partnered hospitals, although this effect was not strongly statistically significant. The results of this study have several applicable results for future practice. ACOs, or AAOs in the case of anesthesia providers, may not reduce costs in the initialization process of coordinated care implementation. Yet, importantly for anesthesia leaders, an increase in value-based care as measured by outcomes could result in viable savings later down the line, thus stimulating hospital development and patient population health in tandem.
Innovative healthcare delivery mechanisms will continue to encourage partnerships among healthcare providers. Anesthesiologists and other anesthesia providers, as healthcare practitioners active in multiple stages of perioperative care, will effectively serve as a bridge in this initiative to achieve the highest level of care possible for all patients.