Historically performance measures in health care focused on individual clinicians, not systems. The Patient Protection and Affordable Care Act (PPACA) encourages the formation of accountable care organizations (ACOs), an idea designed to completely overhaul the nation’s health care system. Interest in ACOs has increased dramatically since PPACA’s passage as it created a new payment model under Medicare, and it fosters pilot programs extending the idea to Medicaid and private payers.[audio:http://hospitalstay.com/wp-content/uploads/2010/10/5-15-Better-Things.mp3|titles=Better Things]

In creating ACOs, Congress hopes that providers will work together more effectively to improve health care quality and slow spending growth. Critics argue that ACOs will focus too much on the bottom line and either prevent or delay the delivery of medical care, or even use the newly-established leverage to demand unreasonable prices from payers.

In a recent article appearing the October 20, 2010 issue of The Journal of the America Medical Association, Elliott S. Fisher, MD, MPH, and Stephen M. Shortell, PhD, MPH, MBA, examine this new methodology for the delivery of health care in the future. In their article “Accountable Care Organizations, Accountable for What, to Whom, and How,” the authors conclude that while the idea of accountability in the delivery of health care has broad appeal, “only a robust, comprehensive, and transparent performance measurement system can reassure the public, physicians, hospitals, others who deliver care, and payers that ACOs are worthy of the name.”

An integral part of implementing ACOs will be measuring processes and outcomes across the health care continuum to support improvement and accountability, while at the same time reducing the burden associated with such a performance measurement. The authors conclude that the success of ACOs depends upon the ability of the Centers for Medicare and Medicaid Services, private payers, physicians, and health system leaders to work together in establishing performance measurements and an evaluation framework that stays true to its original intent (advance accountability to patients and payers while supporting broad dissemination of successful innovations).