CHICAGO — On a stormy evening this spring, nurses at Dr. Gary Stuck's family practice were on the phone with patients with heart ailments, asking them not to shovel. The idea was to keep them out of the hospital, and that effort — combined with dozens like it — is starting to make a difference: Across the city, doctors are providing less, but not worse, health care.
For most health care providers, that would be cause for alarm. But not for Advocate Health Care in Oak Brook, Ill., a pioneer in a new approach known as "accountable care" that offers financial incentives for doctors and hospitals to cut costs rather than funnel patients through an ever-greater volume of costly medical services. Under the agreement, hospital admissions are down 6 percent. Days spent in the hospital are down nearly 9 percent. The average length of a stay has declined, and many other measures show doctors providing less care, too.
This approach is one small part of a growing effort by providers to hold down costs without restricting needed care. Nationwide, health care spending has grown in the last three years at the slowest rate since the federal government started keeping data more than 50 years ago. While the bulk of that is related to the poor economy, changes among insurers and health care providers have contributed as well. If the trend continues, even at a reduced pace, it could help alleviate Washington's long-term deficit problems and ease the strain on family budgets.
But even as more health systems seek to replicate Advocate's early success, its experience indicates it may be very hard to expand the approach and keep medical costs from resuming their relentless rise.
Nonetheless, the Affordable Care Act, President Barack Obama's health care law, has helped encourage a shift to Advocate's payment model. Such agreements were merely a theory four years ago. But an estimated 428 accountable-care organizations now cover 4 million Medicare enrollees, and millions more people with private insurance.
Under Advocate's deal with BlueCross BlueShield, certain patients are assigned to the accountable care framework — about 380,000 — and their health costs are projected. If Advocate achieves savings below that amount while meeting explicit quality targets, it splits the money with the insurer. If not, its revenue is at risk.
Thus doctors and hospitals have a direct financial stake in keeping down costs and a reason to promote preventive care rather than rely on the fees they would normally earn from services.