NEW YORK – Healthcare and healthcare policy leaders say the lack of incentives and current financial interests of providers and other stakeholders are barriers to moving healthcare toward more integrated and accountable delivery models, according to a new survey.

The Commonwealth Fund/Modern Healthcare "Healthcare Opinion Leaders Survey" asked leaders for their views on barriers to delivery system innovation and strategies for fostering more accountability and coordination among providers.

"Across the board, leaders in healthcare say that our current perverse financial incentives are the chief barrier to implementing accountable and integrated systems of care that would improve quality and efficiency," said Karen Davis, president of The Commonwealth Fund. "The good news is that the Patient Protection and Affordable Care Act goes a long way toward overcoming these financial barriers and paving the way for a high-performance health system."

Many of those surveyed support providing special payment arrangement to accountable care organizations (65 percent) and giving providers financial incentives to practice in ACOs (65 percent) – similar to provisions in the Patient Protection and Affordable Care Act signed into law earlier this year.

ACOs are provider-led healthcare systems that are accountable for patient health outcomes and coordinate healthcare across providers and settings. They can take many forms, including tightly integrated systems like Kaiser Permanente, with hospitals and physician group practices all under the same umbrella, and physician group practices like those that took part in the five-year Medicare physician group practice demonstration.

Respondents support the growth of more integrated models of care delivery, like ACOs and integrated delivery systems, but also voiced concerns. Nearly three-quarters of opinion leaders said they were concerned or very concerned with providers acquiring excessive market power and dominance.

To safeguard against such market share, a majority of healthcare leaders (56 percent) support regulation of ACO payment rates in regions with insufficient market competition – similar to the way a public utility is regulated. To alleviate concerns that accountable models of care would encourage providers to withhold appropriate care, more than eight in 10 leaders support the development of performance metrics for ACOs, as well as increased transparency and public reporting on quality of care, resource use and costs.

Other findings include:

• 63 percent of opinion leaders support or strongly support development of a national accreditation system for ACOs.
• 77 percent support or strongly support establishing standards for primary care capacity as a condition of qualifying for payment as an accountable care organization.
• 62 percent support exempting ACOs from antitrust and other legal barriers to coordinating care and sharing cost information in exchange for meeting performance, disclosure and accreditation standards, with support particularly high among leaders in healthcare delivery (80 percent).