Are Medicare Locals Accountable

I recently came across an interesting article in Hospital & Health Networks online magazine titled “Chasing Unicorns: The Future of ACOs“.

The Accountable Care Organization is to a very large degree the US equivalent of the Australian Medicare Local, and I love the quote used by the author of the article:

“The accountable care organization is like a unicorn, a fantastic creature that is vested with mythical powers. But no one has actually seen one.”

As the government announces the wave 2 ehealth sites in Australia, I am starting to feel like our US colleagues, what is this new health service model we are talking about really look like. As we try to picture what a Medicare Local looks like we are unfortunately limited to our experience of how we deliver healthcare, and trying to squeeze the new models into our old mindsets. The challenge with that is that we still think of bricks and mortar constructions of healthcare delivery, with some technology in place to expedite the administration of the service. I think we need to start thinking differently. Why can’t a Medicare Local or ACO be a virtual entity, living in the connected world, with possibly a bricks and mortar entity acting as the administration, i.e. where the cheques are mailed to if needed. The goal would be to have the patient’s homes as the “bricks and mortar” of the model and use the technology to deliver services directly into the patient’s homes. That would mean that doctors don’t need to invest in expensive real estate that they only use for 40 hours a week, they would be able to work in a virtual environment and find a time that suits them. It would mean that patients would have access to expertise outside the direct geographic area, maybe even half way around the world they would be able to link to a doctor when they need it, even if it is 2AM at the patient’s home.

The idea of virtual organisations providing services is not a new one, but it is something we haven’t embraced in healthcare. In Australia we have some of the basics in place for delivering such a service in place, or being prepared. National provider registration enables us to deliver care across the whole continent, irrespective of where we are located. The National Broadband Network will ensure that every home has access to a fast reliable data delivery service, and the upcoming changes in the MBS to enable direct reimbursement for remote consultations provides a reimbursement model. What we now need to do is redefine what a Medicare Local can deliver in such a remote setting. The obvious first step would be in managing patients with chronic disease, recognised as the most expensive and least well managed segment of healthcare.

I look forward to seeing the first virtual Medicare Local or Accountable Care Organization, I believe it will demonstrate that we are starting to realise teh full potential of information technology in healthcare to do more than just store information, it can actually be a powerful tool in delivering healthcare.

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One Response to “Are Medicare Locals Accountable”

  1. Ian Banks Says:

    Absolutely in agreement!

    Here in New Zealand the Ministry is seeking a ‘patient Centred Medical Home’ but nobody seems to know what the beast will look like.

    The first thing, I believe, is for everybody to work from the same page-Primary/Secondary Health/family/ and support services. This dictates a virtual Electronic Health Record with appropriate access levels. Currently, the left hand doesn’t know what the right hand is doing a lot of the time, and Joe Public suffers this!

    We need to address the problem of a health structure based around ‘silos’ of disease specialisations which cannot fit the multiple problems of Chronic Disease and Disability.
    We return people possessing chronic problems to the community without the Tools (monitoring equipment/ assistive devices) , Knowledge (and confidence) to manage their condition, and then become frustrated (along with them) with the revolving door of Hospital and GP presentations!

    Albert Einstein, I believe, said that ‘no problem was ever solved at the level in which it was discovered’ (or words to that effect).

    We, as Health Professionals, know the problem. We need to brave enough to stick our necks out and embrace a whole new concept which is our only real option.

    We owe it to our fellow man.

    Look forward to your updates!

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