With the recent news that four more participants in CMS's Pioneer ACO program are dropping out, the future of this important piece of the Patient Protection and Affordable Care Act is in doubt, now that just half of the original 32 sites remain.

Former Utah governor and HHS Secretary Mike Leavitt, a Republican who is no fan of the ACA, said at last week's inaugural Healthcare Analytics Summit, hosted by data analytics company Health Catalyst in Salt Lake City, that the future of Medicare ACOs may well depend on whether the remaining 16 Pioneer ACOs renew their contracts next year.
 
In fact, Leavitt, who now runs the consulting firm he founded, did something that current Republican members of Congress seem to avoid: acknowledge that the conservative Heritage Foundation proposed the idea of insurance exchanges — which he said are "here to stay." Pilots around risk-based payment grew out of ideas he championed during the Bush administration, he added. Leavitt also placed much of the blame for healthcare's woes on the dominant fee-for-service paradigm, which encourages high-cost services rather than effective, efficient care.

Leavitt's issue was with how much say government should have in reforming American healthcare.

[See also: HHS Secretary Leavitt inaugurates value-driven healthcare plan.]

Whether CMS is involved or not beyond next year, an increasing number of health systems are finding that accountable care is the right way to go, thanks in no small part to analytics. Leavitt himself predicted that 20 million Americans would be part of risk-based care contracts in the next 10 years, a significant number, but still less than 10 percent of the nation's population.

The move to accountable care will happen "slowly but surely," affirmed Health Catalyst founder David Burton, MD, who now serves as senior vice president for future product strategy.

Regardless of the direction of ACA implementation after November's midterm elections and the future of the Pioneer ACO program, health systems nationwide are seeing the necessity of becoming more accountable for the care they deliver.

"We're not an ACO," said Gene Thomas, CIO of Gulfport Memorial Hospital, Gulfport, Miss. "But I submit that we need to act like an ACO." That means turning to analytics.

Thomas said that if it were feasible, it would be better for patients and less expensive for payers to pay for doctor visits for chronic care, make those with congestive heart failure take their medications and have clinic staff personally walk each person two miles a day than to admit them through the emergency department. Indeed, Leavitt said that the most important competency of an ACO is the ability to change patient behavior
"What's best for the patient is lower cost," Thomas added, invoking the "Triple Aim" of safer care, improved population health and reduced spending.

However, in fee-for-service, as hospital margins fall, insurers still pay the same for the life of their contracts. But Big Data done right can shift the dynamics, giving providers stronger negotiating power with payers. "This is where shared savings come in," Thomas said.