Five Common Accountable Care Questions Consumers Ask Doctors

By Catherine Field; Market Director of Senior Products

Humana of Washington and Oregon

“Accountable” and “value-based” are often-used terms in health care today, but what do they really mean when it comes to you and your health? Following are answers to commonly asked questions about accountable care.

What is accountable care, and how is it different from the way health care has worked in the past?

Traditionally, health care in the United States has operated under a “fee for service” model in which doctors are paid based on the number of services they provide to patients. As a patient, this means that your doctor gets paid each time he or she provides you with care. Additionally, if you require medical attention from multiple health care providers, such as physicians, specialists, nurse practitioners and others, it’s likely that they did not speak to one another to coordinate your care. Ultimately, this model may mean highly fragmented and inefficient care, resulting in medical tests and procedures that are unnecessary or duplicative.

The health care industry is shifting toward an accountable, value-based approach to care in which care revolves around you: the patient. In this model, doctors are incentivized to take steps that improve your health outcomes. Essentially, primary care physicians, specialists and hospitals work with insurers to enhance the coordinated care experience for your overall health

How do I benefit from my physician entering into an accountable care relationship?

Accountable care is designed to benefit the patient in several ways, such as the following:

· More time with your doctor. In accountable care settings, doctors are able to spend more time with you as the emphasis is placed on value of care versus the volume of care provided to patients. This allows you the opportunity to ask more questions and learn about your health.

· Increased focus on preventive care. Because doctors in accountable care relationships share in the responsibility of keeping patients healthy, greater emphasis is placed on the quality of a patient’s overall health, so total patient care, including wellness screenings and other preventive measures that may help keep you healthy in the future, are a key focus.

· More coordinated care: Your doctor will have a more complete picture of your health because they will be in close communication with the other doctors you see and have greater access to your health records and other documents to help inform their decision making.

How will I know if my doctor enters into an accountable care relationship?

You may not necessarily know about your doctor’s accountable care relationship, however, you might notice a more coordinated care approach, more emphasis on preventative care and a better patient experience with improved long term quality outcomes.

How do insurers and providers work together in an accountable care model?

Insurers, like Humana, have extensive experience with accountable care and offer various tools and capabilities to help health care providers, hospitals and health systems become successful accountable care providers. These partnerships include value-based incentives for providers for quality care improvements

Will my insurance coverage remain the same if my doctor enters into an accountable care relationship?

You should not experience any changes to your benefits or the way you pay for your health care if your doctor is part of an accountable care relationship. This is due in part to a greater emphasis on accountable care as a result of the Patient Protection and Affordable Care Act (ACA), and accompanying comprehensive health insurance reforms.

Are there accountable care relationships where I live?

There are a number of accountable care relationships in the Puget Sound region. For example, Humana, which offers Medicare Advantage plans in this region, has formed accountable care relationships with The Everett Clinic, The Polyclinic and Iora Primary Care.