Noted business professor Clayton Christensen and colleagues discuss the challenge that new health regulations face in the context of physician and patient behaviors that may remain unchanged.

The article, “Christensen, Flier and Vijayaraghavan: The Coming Failure of Accountable Care,”  hints at the major challenge in engaging stakeholders in meaningful change, when custom, economic drivers, and human nature do not reinforce the changes enacted. Perhaps we will end up with a two-tier system, not based upon economics, but based upon compliance and attitude.

The Everett Clinic, as described in the article, has told Medicare patients that they must change to Medicare Advantage – which promotes preventive care and disease management – or seek care elsewhere, in the old fee-for-service model.

The article states that Accountable Care Organizations (ACO’s) are on the hook for patients who don’t comply with recommended treatment or lifestyle changes. In other words, there is a misalignment of interests.

In the old fee-for-service model, hospitals and physicians are paid more for caring for the sick, including those whose problems are of their own making based on lifestyle decisions and avoidance of preventative measures. A system that has one-sided economic sanctions against physicians based upon patient outcomes may induce doctors and even hospitals to deny non-emergent access to certain patients in favor of those who engage in healthier behaviors. The ethics of such care denial have been challenged in this article. Ultimately, the development of ACO’s may limit care access to those who need it the most.