Half of heart disease patients don’t take their medications as recommended. As a result, they end up in the hospital more often. Yet a recent study of cardiologists found most didn’t know if their patients are taking the medicines they prescribed to help prevent heart problems. Most said they don’t ask if patients are taking their medications, even though the doctors know how important it is.
A new form of health plans, called accountable care organizations (ACOs), are bridging the communication gap between doctors and their patients. ACOs are integrated networks of hospitals, doctor’s offices and other health care facilities that get paid by an insurer based on the quality and efficiency of care their patients receive – not how many visits, tests, surgeries and hospital stays they bill. Working together with the insurer, they can have access to information about an ACO patient’s care.
That means the doctor has more information at his or her fingertips when the patient visits. Has the patient been filling his prescriptions regularly? What were the results of the most recent tests he had? What other doctors have seen him, and what treatment or recommendation came from that visit?
Where it’s working
Leaders from two organizations offering ACOs in cooperation with Aetna talked about the advantages of ACO arrangements at a recent bswift conference.
“Too often doctors don’t know what’s going on with the patient at other doctors or hospitals. The insurer knows,” said Dan Styf, senior vice president at Memorial Hermann Health System and CEO of the Memorial Hermann Health Plan in Houston. “Data from claims gives us perspective, so when the patient is sick and shows up in the system, we can see what is happening and take action.”