ACOs, or Accountable Care Organizations, continue to be a hot discussion topic in health care reform. In the current issue of JAMA, Duke’s own Barak Richman and Kevin Schulman provide a unique business perspective on the implementation of ACOs. One of the issues they raise is the potential for the establishment of ACOs to result in health care system monopolies. They warn that health care systems might align under the promise of market dominance and not necessarily with the intention of improving health care quality or efficiency. In order to prevent a misaligning of goals, they urge that evaluation of ACOs should maintain focus on health care quality and efficiency.
Another recommendation they suggest is for health care systems to align under a horizontal vs. vertical or “bricks and mortar” approach. Whereas vertical networks focus on established hospitals and other infrastructure, horizontal networks would connect more fluid, geographically diverse care specialists. To me it seems like this idea mirrors themes in social and professional networking. Horizontal networks may take less time, investment, and have the potential to spread much more quickly than conventional geographically constrained networks. However, in my opinion a key challenge to the horizontal vs. vertical approach is how seemingly unconnected groups will be able to share information and provide coordinated care. I think that a potential solution would be the establishment of personalized health care records. Electronic personalized health care records would follow the patients, contain all their health care information, including their personalized health plan, and provide a virtual medical home that could provide a universal medium for exchanging health care information among horizontally connected providers. Without a universal medium to maintain coordination of care and ensure that information is efficiency conveyed, it may be difficult to envision how horizontal networks could provide cohesive care. In an ongoing era of rapid technology development, a personalized health care record would provide a potential means of increased portability and exploration of new options for new health care delivery models.