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Accountable Care: Not Your Father's HMO

Noel Scott, a St. Luke's technician, at the St. Luke's clinic in Baker City, Ore. reviews a patients X-rays.
By Dr. David C. Pate, News and Community
December 3, 2013

Is accountable care the same thing as the managed care of the 1980s and ‘90s, health maintenance organizations rebranded?

The answer is a resounding “No!”

These are generalizations, and this is not to say that there were not isolated instances where managed care was successful, but here are the top 10 differences:

  • Managed care was designed, implemented, and operated by insurance companies. Accountable care is physician- and provider-led.
  • Managed care was premised on lowering costs by restricting access to physicians and services.  Accountable care is premised on lowering costs by ensuring prompt access to the right care at the right time.
  • Managed care strategies often succeeded by issuing denials for services to save money. Accountable care promotes services that result in outcomes that are the best they can be, based on the idea that timely, high-quality care ultimately results in lower costs.
  • Managed care takes a short-term view. Because enrollees changed plans frequently, managed care did not make long-term investments in enrollees’ health. Accountable care takes a long-term view of improving health as a critical strategy to reducing future healthcare costs.
  • Managed care’s primary endpoint was reducing costs of care. Accountable care has three primary endpoints: improving health, improving care, and ultimately, lowering healthcare costs.
  • Managed care often resulted in adversarial relationships among insurance companies, patients, and healthcare providers. Accountable care shows promise in promoting increased collaboration. St. Luke’s, for example, has partnered with the Medicare program, the state Medicaid program, and an insurance company, SelectHealth, to design new care and business models to foster more value and better care than traditional Medicare, Medicaid, or insurance company products. Accountable care also is patient- and family-centered, so education and treatment are tailored to patients and their families and to achieve patients’ goals. Patients are involved in the decision-making, and this is a vast improvement over managed care.
  • Timing is everything. The healthcare delivery system is very fragmented, and was even more so in the ‘80s and ‘90s. Physicians and hospitals are working better and closer together and able to coordinate care better now. We are creating programs with physician leadership that are more team-based and that provide better coordination of care, and these attributes will contribute to a greater degree of success of accountable care over managed care.
  • In the ‘80s and ‘90s, few physicians were on electronic health records. That’s less and less the case. St. Luke’s Clinic is up and operational on an electronic health record that allows for better and safer care coordination. Patients can view their own health records online. And electronic health records are greatly advanced over what existed in the ‘80s and ‘90s and offer all involved providers the complete medical information of the patient. The ability to add clinical decision support tools and utilize data analytics are facilitating the use of evidence-based medicine and providing caregivers with meaningful, actionable data to drive quality improvements.
  • The philosophy is different. We know we have to change the care model and the business model, to support the new care model and to ensure that the incentives are aligned to what we are trying to achieve. We know that if we want to change health care, we can’t keep doing things the same old way. All of this requires innovation, and there is much more innovation in health care today than there was in the ‘80s and ‘90s. This holds promise that we can truly transform health care this time!
  • Managed care tried to succeed before providers had engaged and before the resources were developed to support it. Today, physicians understand that the healthcare system is broken and unsustainable and are willing to be a part of leading the change required.
Additionally, there are more physician assistants, nurse practitioners, nurse educators, patient navigators, care coordinators, health coaches, clinical nutritionists, and other professionals, all of whom are necessary to better engage patients in their own care and to coordinate care.

St. Luke’s believes that accountable care will succeed, for all the reasons that managed care did not. Many resist these changes, so we know that we must prove it. That is our journey.

We plan to make public our results, sharing the results of our innovations and trying new ideas until we find solutions. St. Luke’s is committed to transforming health care to improve the health of the people in our region, to be the national leader in quality, and to drive health insurance premiums down.  It is one more example of how St. Luke’s is taking care forward.

About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.