What if insurers operated more like ACOs?


I've been mulling over a former Obama administration official's prediction that accountable care organizations will replace insurers since I covered his comments a few weeks ago.

Former White House Healthcare Adviser Ezekiel Emanuel said he expects insurers to be obsolete by 2025 when ACOs will have assumed both clinical and financial risks for their members. "I do believe that the health insurance companies that we all love to hate are going away," he said during a speech at Princeton (N.J.) University. "I think this is the wave of the future."

Maybe insurers don't have to completely cease to exist. Perhaps they can evolve into an ACO-like model. In all my reporting of ACOs, many already have begun to successfully control costs and boost quality care. Anthem Blue Cross in California, for example, increased by 44 percent the appropriate prescribing of antibiotics for bronchitis through one of its ACOs.

And two other aspects of healthcare that I highly value--communication and coordination among my providers--are strongly emphasized throughout ACOs. One of the biggest problems with healthcare today is the lack of coordination driving unnecessary, and often redundant, services and procedures. That's why Cigna uses patient care coordinators, who ensure all providers participating in an ACO deliver appropriate, coordinated care.

What's more, insurers that successfully coordinate care consistently rank high in customer satisfaction. Kaiser Permanente exemplifies that coordinated care model with its streamlined, integrated care and focus on prevention, wellness and electronic health records. Essentially functioning like an ACO with strong communication between the insurer and provider side of care, Kaiser's model has allowed the company to provide care that's up to 20 percent below market average costs.

Given that ACOs can reduce costs, enhance quality and improve coordination, I think they are a strong contender for helping to reform the healthcare industry. It's likely Emanuel spoke too generally and harshly of insurers. I hardly think they'll be out of business in 10 years, given their intricate involvement within the healthcare delivery system.

But Emanuel gave us some food for thought, and I don't think we should disqualify his comments simply because they seem a tad outrageous. Determining how insurers can adapt to the changing times and evolve in a post-reform market is a vital question insurance companies should ask themselves.

There's no doubt the insurance industry is shifting as the Affordable Care Act requires a new business-to-consumer approach and puts greater importance on quality of care and coordination. Incorporating ACO models throughout their overall business processes would likely serve insurers well in meeting those reform demands. And they could see better customer satisfaction, which could in turn, translate to a larger membership. Those are all worthy goals for a company to pursue. - Dina (@HealthPayer)