The New World of Accountable Care: A visit to the University of Southern California 

July 1, 2013

Southern California in general and the campus of USC in particular are beautiful this time of year. The temperature and humidity are such that registration for conferences happens outside on a green lawn under a tent. Such were the circumstances surrounding my recent visit to Los Angeles to present at the 7th International Conference on Social Work in Health and Mental Health on the USC campus I have done a lot of presentations and attended a lot of conferences but registering for the conference outside – never. – See more.

My workshop was titled The New World of Accountable Care: What It Means for Behavioral Health. Given the international nature of the conference, it was hard to imagine the attendees would be interested in hearing a yank talk about accountability. Add to that that I was a psychologist at a social work conference and I fully expected to be talking to myself for the 90 minutes allotted to me. I needn’t have worried because the talk was well attended. The majority of those in the session were from the US but there were probably eight other nationalities represented including Israel, Australia, Sweden and Qatar.

The talk focused on the clinical and financial accountability in medical and behavioral healthcare. It was the kind of topic that my kids would beg to get a root canal if they could be excused from attending. Thankfully, the audience was more interested (or maybe just more polite) since they stayed for the entire talk, offered great questions and they didn’t throw anything. (I weigh that last criteria pretty heavily when people ask “How’d your talk go?”)

Given the audience’s interest, it became apparent that accountability is a universal concern. While we in the US are focused on the Affordable Care Act (ACA) and what that will do to our health care system, it’s easy to forget that health costs and the drive towards clinical excellence concern people of all nationalities. It’s easy to forget that, according to the World Health Organization, depression is the number one cause of death and disability not just in the US but in middle and high income countries around the world. All healthcare providers want to provide superior care and managers of healthcare want to control costs. What’s becoming clear is the future of healthcare isn’t about either one of these parts but rather it’s about both taken together. That is, it’s not about quality or cost, it’s about quality divided by cost which is value.

Cost data is pretty easy to obtain but data about quality has been more elusive. Setting aside all the tired arguments that “this is an art not a science”, behavioral healthcare is being asked to provide demonstrable and measurable outcomes (i.e. “quality”) by those who pay the bills. It’s a fair request and one we can do. But we must be willing to change and adapt to a new healthcare paradigm that pays for doing instead of trying.

These messages were well received by my audience because, I suspect, we are all trying to achieve the same end – the highest quality at the best cost. To do so will require some major changes for us and some will find those changes difficult. Maybe that root canal isn’t looking so bad?