Health insurers must abandon silo mentality to profit from ACO model

Healthcare payers must break out of their silos and share a more "patient-centric view” with providers, analysts warned during the AHIP Institute conference in San Francisco last week.

Insurers “can’t be silo-based anymore," Robert Williams, director of Deloitte Consulting's healthcare practice, told FierceHealthPayer during a break at the show. "ACOs could be win-win by increasing outcomes and patient satisfaction while decreasing resources and costs."

Despite many health payers' fears that accountable care organizations will stifle competition and provide few benefits, ACOs will actually result in a more collaborative, value-based system that focuses on the whole patient and emphasizes wellness and preventive care.

"ACO is a restrictive, emotionally-laden term that misses the big picture," Williams said, adding that an accountable care model is "just one component of a broader trend moving toward value-based reimbursement," which requires a more collaborative, interdependent relationship between insurers and providers.

Folks from PegaSystems shared this perspective. "The ACO is a piece of the larger puzzle helping drive collaboration," Bill Marshall, principal, healthcare industry solutions for Pegasystems, told FierceHealthPayer.  Providers often consider payers as the intrusive enemy, but ACOs finally help break down that stigma as payers and providers work together for a common goal, he added.

Another benefit of collaboration in an ACO structure is an increased focus on patients' overall health and wellness as well as preventive care. Payers can see a patient's big picture related to health because they have all the medical information from all providers treating the patient. If working together within an ACO, a health plan could produce a patient report card in advance of an appointment to help a provider proactively care for the patient, Marshall suggested. Payers could, for example, alert a doctor to a potential overlap in care or a patient's failure to take prescribed medication.

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