Much of the discussion taking place about accountable care organizations focuses on the provider’s accountability in population-based healthcare. What appears to be getting lost in this discussion is the patient’s role in the accountability equation. The challenge most providers face with accountable care organizations is not just how to manage risk, but also how to assist and coach individuals on making positive and sustained changes in their lifestyles.
Ultimately, the success or failure of accountable care organizations, should they become a reality, will depend upon their ability to establish genuine partnerships between those who dispense medical care and those who consume it.
The accountability partnership is a two-way street. Consumers cannot determine the medical efficacy and cost-effectiveness of tests and procedures without unbiased knowledge of the benefits, value, and costs associated with various diagnostic and therapeutic modalities.
Considering that up to 80% of health costs are related to chronic conditions that have their origin in poor lifestyle behaviors, providers must find ways to motivate the chronically ill patient to make every effort to modify those lifestyle behaviors that can worsen their condition. While physicians may know evidence-based approaches to disease management, the very nature of the physician-patient interaction (“I’m the doctor—you need to do what I tell you”) can thwart patients’ compliance with the physician’s prescribed solutions. Patients often express that they feel rushed in the exam room, and the language of medicine can create a palpable communication barrier between physicians and patients. The physician’s focus is on “what is your chief complaint?” (i.e. what can I fix) whereas the patient’s is “how do I make my life better”?