Physicians' dissatisfaction about managed care was contagious—and patient perception that the healthcare system was stinting on their care contributed to its downfall, he added.
Managing patients' and physicians' expectations and better educating them about the differences between managed care and accountable care—such as the increased emphasis on quality of care, for example—could help the new model avoid the same fate, said Jonathan Gruber, PhD, a professor of economics at the Massachusetts Institute of Technology.
Dana Safran, senior vice president of Blue Cross Blue Shield Massachusetts, agreed, saying healthcare organizations must frame the discussion in terms of accountability for both cost and quality. Outcomes are the counterbalance that was lacking in managed care.
"The question is [whether it will] be enough from the perspective of the patient," she said. "There's a lot of room to do this injudiciously in terms of incentives."
The biggest challenge facing accountable care, Safran said, is the fragmentation, chaos, and lack of communication that plaques the industry. That will affect whether patients successfully self-manage their care after leaving the physician's office or hospital or whether lack of understanding and motivation, as well as day to-to-day problems and financial barriers will get in the way.