1. High Performance Accountable Care: What Do We Need to Do?
Stuart Guterman
Vice President, Payment and System Reform
Executive Director, Commission on a High Performance Health System
The Commonwealth Fund
Alliance for Health Reform
Briefing on Accountable Care Organizations
Washington, DC
May 13, 2011

2. The Need for Coordinated, Accountable Care
Access problems
Waste and inefficiency
Poor coordination of care—especially if multiple doctors are involved
Public Support for Policies to Improve Coordination
People want more accessible, coordinated, well-informed care
People think doctors working in teams or groups improves care
Majority of Americans say the health care system needs fundamental change or complete rebuilding

3. Moving Toward a High Performance Health System
Essential elements of a high performance health system:
Affordable coverage for all
Aligned incentives to promote quality and efficiency
Increased accountability
Improved coordination of care
Effective leadership in the policy and health care communities
There’s a strong relationship between the way we pay for health care, the way health care is organized, and the way it is delivered
The creation of ACOs as a new type of provider in the Affordable Care Act recognizes the importance of coordinated, accountable care in achieving the goals of a high performing health system:
Better health
Better care
Lower cost
This new initiative is consistent with all five elements above

4. Recommendations from the Commonwealth Fund Commission on a High Performance Health System
Overall goal: to achieve a high performance health system that is organized to attain better health, better care, and lower costs
Strong Primary Care Foundation
Accountability for Quality of Care, Patient Care Experiences, Population Outcomes, and Total Costs
Informed and Engaged Patients
Commitment to Serving the Community
Criteria for Entry and Continued Participation That Emphasize Accountability and Performance
Multi-Payer Alignment to Provide Appropriate and Consistent Incentives
Payment That Reinforces and Rewards High Performance
Innovative Payment Methods and Organizational Models
Balanced Physician Compensation Incentives
Timely Monitoring, Data Feedback, and Technical Support for Improvement

5. Important Considerations
There is a real need for coordinated, accountable care that is patient-centered, effective, and efficient
There is an important relationship between payment methods, the organization of health care delivery, and health system performance
The current payment system encourages fragmented, uncoordinated care and does not reward value
Changing the way health care is paid for, organized, and delivered is essential to achieve the Triple Aim of better health, better care, and lower costs—and there’s a lot to be gained from achieving these goals
The Affordable Care Act, in provisions like the one that creates ACOs, provides a set of policies that can help move the health system toward these goals
Success requires bold action, leadership, and collaboration on the part of Medicare, other public programs, and private insurers, as well as hospitals, physicians, and other providers, and patients
For ACOs to be successful, they will need a clear idea of what is expected of them, a strong connection between their performance and how and what they are paid, and data and technical support in making the changes necessary to improve the way health care is delivered and reduce cost growth