I came across an interesting blog post in which Joseph Kvedar, MD, Director of the Center for Connected Health, Partners HealthCare responded to an opinion piece in the Wall Street Journal that predicts the failure of Accountable Care Organizations (ACO). Kvedar does a fine job of addressing each of the arguments presented in the piece; challenging the notions that ACOs are latter day HMOs and that physicians will not change their behavior to fit the new model. However, both articles agree that ACOs will not succeed without changing patient behavior. For example, ACOs cannot prevent patients from getting treatment outside of their network of providers. The WSJ piece offers a scenario where a patient lives in Massachusetts for half the year and Florida for the other six months (also known as a snowbird to those of us who live in Mass). If an ACO in Massachusetts is managing the patient’s care and the patient receives care in Florida, it would still be responsible for managing the patient’s medical costs, despite the fact it can’t manage the Florida care. However, the biggest hurdle may be the fact that providers cannot hold patients accountable for failing to comply with recommended treatments or lifestyle changes. Kvedar goes so far as to say the entire public perception of chronic illness needs to change. “The prevailing sentiment nationwide is that chronic illness is an accident that leaves patients as victims to be cared for and covered by insurance. The most effective way to move patient/consumer accountability forward would be to acknowledge that lifestyle plays an enormous role in our most prevalent and costly illnesses.” Rewarding patients for improving their health and maintaining a healthy lifestyle would give them skin in the game, but Kvedar says politicians are not likely to implement such policy. What do you think? Is patient accountability critical to ACO success?