ACO Success Will Depend Upon The Patient-Centered Communication Skills Of Providers

Accountable Care Organizations (ACOs) and “bundled payments” are set to play a central role in the Affordable Care Act.  Under accountable care, physicians and hospitals would be paid out of a “single payment” from CMS or health insurers for all the care needed to treat a clinically defined “episode of care” like a heart attack.   The premise is that bundle payments will incentivize physicians and hospitals to deliver more efficient, high quality care.

Much has been written about the health information technology infrastructure needed to support ACOs.  Experts also underscore the need for providers (physicians and hospitals) to get patients with conditions like heart failure more engaged in prevention and self-care.  After all, as much as 90% of the “care” for chronic conditions like heart failure is provided by the patient and their care givers at home.  But effectively engaging patients has been a difficult nut to crack for health care providers.

What Can ACO Providers Do To Increase Patient Engagement?

Here’s the short answer – improve the quality of communications between physicians and patients.  After all, physician-patient communications is how most patients are diagnosed and treated.

The degree to which patients and physicians agree on key aspects of the diagnosis and treatment is said to be an indicator of communication effectiveness.  Disagreements such as the nature or severity of a medical condition or the need for a new medication represent a breakdown in physician-patient communications.  Such breakdowns are common and are closely associated with patient behavioral issues such as non-compliance, excessive health care use, and decreased satisfaction.

High levels of physician-patient agreement are linked with more desirable patient outcomes and behavior.  Physicians that use a patient-centered style of communication tend to report much higher levels of agreement with their patients on critical diagnosis and treatment issues.

The Current State of Physician-Patient Communications

A 2011 study of patients diagnosed with a heart condition, and being seen in a public hospital cardiology clinic, illustrates the scope of the communication problems facing not just ACOs…but all health care providers today.

In the study, 55% of patients diagnosed with heart failure did not recognize (nor agree with their doctor) that they had heart failure.  Even more disconcerting was the finding that “only 15% of those with hypertension agreed with their doctor’s diagnosis.

Physician-Patient Disagreement And A Lack of Patient-Centered Communication Are Greatest Amongst Population Groups That Are The Sickest And Most In Need

African-Americans experience heart failure at a rate this is 20 times higher than their white counterparts.  Physicians that treat blacks are less likely, according to researchers, to use a patient-centered communication style.

Numerous studies have revealed that when treating black patients, as opposed to white patients, physicians tend to “provide less health information, are more physician-directed (versus patient-centered), spend less time building a rapport with patients, and are more verbally dominant.“  In other words, the patients that are in greatest need for patient-centered communications, and the benefits it provides, are presently the least likely to receive it.  The lack of high quality patient-centered communication is not limited to minority groups.  An estimated 60% of practicing physicians use a physician-directed communication style.

 The Take Away?

Needless to say, the quality of physician-patient communications in the U.S. does not bode well for the success of ACOs.  Health plans, physician groups and hospitals looking to realize the financial benefits of bundled payments and accountable care should give serious consideration to investing in benchmarking tools and communications interventions that will measurably improve the quality of physician-patient communication both in the office and hospital.

That’s my opinion…what’s yours?


Cené, C. et al. The Effect of Patient Race and Blood Pressure Control on Patient-Physician Communication. Journal of General Internal Medicine. 2009. 24(9):1057–64

Sarkar, U. et al. Patient-physicians’ information exchange in outpatient cardiac care: time for a heart to heart? Patient Education and Counseling. 2011. Nov;85(2):173-9.

Johnson, R. et al. Patient race/ethnicity and quality of patient-physician communication during medical visits. American Journal of Public Health, 2004. 94(12), 2084-90.

4 responses to “ACO Success Will Depend Upon The Patient-Centered Communication Skills Of Providers

  1. My thought process is the more information the better. I’m not just going to take a doctors word for something just because they’re a doctor. I want the facts and information to back it all up. Having the ability to access my health records to see what treatment and or tests have been done, the results and plan of action moving ahead.

  2. I agree that in many cases there are disconnects between doctors and patients. The reasons for the disconnect are much greater than racial. ACO and related approaches are not the answer. Adding patients to an already overloaded system is not going to resolve these issues.

  3. Col David Bates

    I totally support your initiative Stephen.

    It really reinforces Talbot Parson’s (1951) role theory and deviance and suggests that people who are ‘patients’ or related to patients need to be supported so that they retain their role of father, mother, shopkeeper, soldier or whatever rather than succumbing to subserviance. Of course some people will relish this and accept the doctor as paternalistic and authoratative not inderstanding why they need to be part of the decision making process.

    People who are patients or potential patients will have to learn how to counter Parson’s ‘health deviance theory’ in this ‘brave new world’ that is being created by the UK coalition government with the ‘Health and Social Care Act’. If they don’t they will be subserviant by definition despite the legislation supposedly putting the person/patient at the centre of the system. Theyneed to be taught their responsibilities – a US author coined the phrase ‘patienthood’ – I need to dig out the reference. Somehow it seems more relevant now than when I first read it over 20 years ago!


    Parsons T (1951), The Social System. Glencoe IL, Free Press.

  4. Like to know source for the statistic quoted, 60% of physicians use a physician-directed communications style. Not questioning use, just want to know the source.

    Assuming correct, 60% physician-directed communications would explain a lot about patients’ lack of understanding about care plans and how to follow through on them as well as, perhaps, their lack of commitment to a care plan. In effect, they are working at a job they didn’t agree to.

    This suggests ACO’s carry a heavy burden of being measured for performance underpinned by processes (communications) they cannot directly influence….how doctors talk to their patients.

    Good article. Thanks.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s