Cartoon Solves Health Care Puzzler: What The Heck Is An ACO?

Ladies and gentlemen! Announcing a whole new film genre: Wonk Cinema!! And what we hope will be the first in a series of CommonHealth cartoons dedicated to helping people stay awake as they learn about important health care changes that affect their lives.

Our first topic: “What the heck is an Accountable Care Organization?” Five minutes, just five minutes, to unravel one of the great mysteries of the universe! Explain the inexplicable! Destultify the stultifying! Also, to cast much-needed light on a health care phenomenon that is sweeping the state and the country…

We’re taking requests for other topics so soporific and esoteric they can only be explained tolerably in a cartoon video. What should we do next? Tiered health insurance? Payment reform? Please lodge your suggestion in the Comments section below.

And deepest thanks to former Boston Globe health care reporter Jeffrey Krasner, now president of Krasner Health Strategies, for lending his deep knowledge and rapier wit to this project.


DOCTOR: You look troubled. What’s wrong?

WOMAN: I’m scared. I got a letter from my doctor that I don’t understand. It’s about how I’m going to be part of an ACO. What in the world is an ACO?

DOCTOR: An ACO is an accountable care organization.

WOMAN: Ugh. What a boring name and off-putting name. What the heck is an accountable care organization?

DOCTOR: An accountable care organization is a collection of hospitals, doctors, and other care providers that coordinate among themlseves to provide high-qaultiy, efficient care to a patient within the bounds of a single payment.

WOMAN: Huh? Oh, sorry. First I didn’t understand you, and then I fell asleep.

DOCTOR: You are not the first. Please try to stay awake. This is important.

WOMAN: Okay, but all I really want to know is what it means to me personally.

DOCTOR: Hmm, okay. Did you ever have a situation where your doctor sent you to a specialist and then you needed your doctor to talk to that specialist?

WOMAN: Yes, one time I had pain in my knee, and my primary care doctor sent me for an MRI.

DOCTOR: Did your doctor ever talk to the orthopedist?

WOMAN: Why, no, I don’t think he did.

DOCTOR: In an ACO, they’ll talk to each other.

WOMAN: Well, how will that make my care better?

DOCTOR: When doctors talk to each other and share information about a patient, the result is better care that focuses on the health of the entire patient, not just the particular condition at hand.

WOMAN: Well why aren’t they talking to each other now?

DOCTOR: Doctors only pick up the phone and talk to somebody when they’re getting paid for it.

WOMAN: So I’ll be paying my doctor to call another doctor who he should have been talking to anyway?

DOCTOR: No, you’ll be saving money.

WOMAN: Huh? How’s that?

DOCTOR: When the different parts of our care system communicate better and eliminate repeat tests and unnecessary treatments, the overall cost of care will come down. And that means your premiums will come down.

WOMAN: I just woke up when you said my premiums would go down. Yay! Hooray! But I’m having a nasty flashback. This sounds a lot like what I remember from the 1990s when my HMO wouldn’t pay for my treatments — it was terrible.

DOCTOR: Yes, it really is a lot like the HMO from the 1990s. ACOs and HMOs both use a similar payment system called capitation.

WOMAN: Decapitation? Like beheading? That doesn’t sound good.

DOCTOR: No, no. Capitation. A system in which doctors or hospitals are paid a fixed amount for each patient they treat.

WOMAN: So let’s say they get $1000 a year to take care of me. Won’t they be trying to spend as little as possible on me so they can save the whole $1000 for themselves?

DOCTOR: Yes, but this time around we have something called P for P.

WOMAN: Oh, you mean like when my doctor asks me to pee in a cup at a check-up?

DOCTOR: No, P for P means pay for performance. The doctors or hospitals get paid more when their patients are healthier and do better, so they have a financial incentive to keep you healthy.

WOMAN: So this is all about financial incentives again? Don’t doctors really care about us, their patients?

DOCTOR: Yes, they do, but it helps to give them a little financial push anyway.

WOMAN: I do feel like my own personal doctor does care about me. Is an ACO going to tell me which doctor I have to go to, like my HMO did in the ‘90s?

DOCTOR: If you’re a Medicare patient, the answer is no — no limits. But if you’re a patient on Medicaid, then probably yes — it will limit who you can see. And if you have commercial health insurance like Blue Cross, they’ll probably be steering you pretty strongly to stay under the umbrella of their ACO.

WOMAN: Hmm, and what about my privacy? The letter I got says that my doctor will be sharing around more of my information, and I don’t want more people to know about my psoriasis and hemorrhoids.

DOCTOR: Don’t worry. You’re information is protected. And sharing patient data will help doctors coordinate care and treat you better.

WOMAN: Okay, but you say this will save money? I just got my new health insurance bill. Why is my premium going up again?

DOCTOR: Look at it this way. The patient has had this condition for 50 years. We can’t reverse it overnight. But I hope at least now you understand what we mean by an ACO.

WOMAN: I do understand — sort of. But now I have a headache.

DOCTOR: Well, take two aspirin and call your ACO in the morning.

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  • Ed

    I like it. It’s hard to explain stuff that’s usually shrouded in a lot of legalese, meditalk and good ole fashion mumbo jumbo. Both of you are pros at cutting through that, so you succeed there. But needs to be about 2:30.

  • Geoffrey Rowan

    You guys addressed the tough questions head on with clarity and a little humor. Nicely done!

  • Marc Lavallee

    Love it, Carey! Great job!

  • Mudlj

    It really is too long, I fell asleep!

  • Anonymous

    I like the idea of a simple explanation for a complicated and boring concept. I have real concerns, however, about the practice of ACOs. Studies show that people do not respond to financial incentives over time – including doctors. And how will the records reflect a better patient? A COPD patient now coughs 100 times a day, instead of 150 because she’s on oxygen?

  • Editrudi

    This video would be much better if it didn’t have robot voices. The script is good, but there’s no way I’m listening to 5 minutes of this.  I would rather turn off the sound and read subtitles…but there aren’t any. 

    • Careyg

      I hear you. We’ll try to record human voices next time. And though there are no subtitles, there’s a transcript at the bottom of the post that you may find helpful…

  • suzy

    The computer-like voices don’t help this at all—-I tuned it all out pretty quickly after all.  Something with a bit more humor would be helpful.  Don’t think this is THE answer.

    • Careyg

      We’ll try harder! It looks like there’s a way to record a voice rather than use the computer-generated ones — please stay tuned…

  • Sherry

    How about a video on how holding medical loss ratios to 80-85% will help consumers with their premiums and, in some cases, give them a premium rebate.

  • Reasonable?

    Excelent Video! I will be sharing this broadly.

  • HealthCareNegotiate

    Great description of a complicated proposition. We’re currently drafting a guide to remedying expected “ACO pain points” based on twenty+ years of experience with changes in the health care system. The intentions behind ACOs are noble but initial designs are never perfect…

  • Beau

    This is exactly an HMO type plan, the doctor incentives will not matter because they will be seeing so many patients to fill a quota, the incentives just won’t matter.  ‘Insanity is trying the same thing twice and expecting a different out come” Good luck in trying to get good doctors as part of these doctor lists.

    • Sandra Fackler

      But trying somewhat the same thing but with changes to fix the previous problems is a good idea.  I like that the doctors must talk.  Currently, the primary has to rely on a written report or sometimes even my second-hand rendition of what I think I heard.  More often, we never discuss what the specialist found out.  I prefer more input.  I have a great clinic attached to our new hospital and while I can see another doctor if I want to, I can stick with my primary, which I prefer.
      For pete’s sake don’t be an Eyore, give the changes a chance before you veto them.  Remember what you said about doing the same thing…  :-)

      • RockyT

        I guess I’m in the minority but my doctor already talks to specialists. The truth is that most “communication” under the ACO model will be through EMR reports. ACO’s are more of the same ole same ole.

  • Elizabeth

    Better than most things I’ve seen so far, but still a little boring. Maybe it’s because you just can’t get around the fact that it’s a fairly boring subject … until you NEED to know the details on how it’s going to affect you.

  • Srimer

    What a great idea–the cartoon!