Calculating ‘Outcomes’ Is the New Health Care Mandate

There’s much to learn about today’s changing health care delivery landscape. A series of new acronyms is out there for the taking, describing everything from U.S. government health care agencies to state boards to medical and provider organizations and private company programs.

“A.C.O.” a.k.a. Accountable Care Organizations, have been receiving much attention of late. One form of what’s now referred to as “coordinated care” organizations, ACOs, as you will learn from our VM Senior Editor John Sailer’s especially informative report, are not easy to define, as each might be, in fact is likely to be, set up differently.

But underneath them, and drawing a parallel to the way many new private and government health care and insurance businesses are viewing their systems, is an important new emphasis for all health care providers, vision care providers among them, to understand.

This emphasis is known as the concept of “outcomes.” What happens to the patient after care is administered or medications or treatments are delivered? Is the health care problem, chronic or acute, corrected as a result of a certain treatment protocol? Is the impairment fixed? What happened as a result of this provider’s treatment? Those are questions being asked right now to determine success, to determine fees.

“Outcomes” is the new benchmark for how all providers will come to be judged. As Sailer explains in this issue’s Cover Story, ACOs are about “converting health care payments from fee-for-service to outcomes-based and by creating financial incentives for health care providers to work together and reduce costs.”

This is clearly a move away from traditional “fee-for-service” valuations for doctors. And that’s what’s behind the big sea change happening now in all health care, vision care included.

Vision care providers, optometrists and ophthalmologists, too, are starting to see this happening, even though the full impact of health care reform and any new structures to vision care delivery may not in fact be fully realized for a few years.

At this stage, it’s important for providers to get educated, understand what’s happening in your local market as well as your state, on this important new front. ■