On the Hot Seat

He works on strategies to make health care better, and cheaper

Dr. Marc A. Bard is the managing director of Navigant Consulting. Dr. Marc A. Bard is the managing director of Navigant Consulting. (John Ioven/Globe Staff)
By Robert Weisman
Globe Staff / April 17, 2011

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Dr. Marc A. Bard is the Needham-based managing director for Navigant Consulting and chief innovation officer for its national health care practice. A physician who practiced internal medicine for 18 years at Harvard Community Health Plan, one of the early health maintenance organizations, Bard, 65, is author, with Navigant colleague Michael Nugent, of the new book, “Accountable Care Organizations: Your Guide to Strategy, Design, and Implementation.’’ He spoke with the Globe’s health care business reporter, Robert Weisman.

Everyone says health care will be delivered in the future through accountable care organizations. If you had to describe ACOs in one sentence, what would it be?

The term organization is a misnomer. It’s really a strategy. And it’s basically a strategy to create an organized, integrated system of care for the patient.

How will patient care change as ACOs take hold in Massachusetts and beyond?

Today virtually all patient care is patient-initiated. The patient feels a need for care. Since the only reimbursable care is a doctor’s office visit or a hospital visit, that’s where all the care takes place. In the future, much of it will be organized system-initiated care. And it will take place in the way that people communicate in the year 2011: through social networks, through telephones, through computers, as well as direct face-to-face.

And will the care be better? Will it be cheaper?

The answer is yes to both. It has to be better and cheaper.

How will life change for doctors working within the new ACOs?

Well, let’s start with primary care, because primary care doctors right now for the most part get reimbursed only for seeing patients, direct patient care. In the future, a primary care doctor will be more like a CEO of a health care system that includes psychologists, nurses, social workers, nutritionists.

Can the current fee-for-service system survive alongside ACOs, or do ACOs replace fee for service?

In the long run, I think the future of fee-for-service practice is very limited, because it essentially rewards volume over efficiency, and as a result it simply isn’t a system that’s supportable.

The federal government recently proposed regulations for ACOs. Was there anything in there that surprised you?

It’s 427 pages of regulations. In reality, trying to optimize care through policy is a little bit like trying to do delicate surgery with a chainsaw. I have no doubt that some of the policies went too far and are too limiting. Some didn’t go far enough and are too broad. At the end of the day, it’s going to be the innovation and creativity of those both giving and receiving care that will determine whether this is successful, not the [government] policies.

Commercial health plans in Massachusetts have been introducing global payment policies. Do these plans need ACOs to succeed, and do ACOs have to work through global payment plans?

They’re two separate but closely related concepts. Global payment basically means that a provider’s system gets a fixed fee for taking care of a patient for a period of time. When it works well, it provides both integration and innovation.

But it’s not required. I know that in Massachusetts the governor certainly wants to move to a global payment. There are some systems, like Atrius Health, that are ready to accept global payment and have accepted global payment. Same with Steward Health; they’ve accepted a fair amount of global payment. But for a lot of the systems, particularly academic medical centers, it’s going to be very difficult for them to accept global payment. We will be living in two different worlds, and ultimately probably we’ll migrate into the direction of global payment.

Some consumers fear they won’t be able to go to the doctors or specialists they want in the new system. Is that a legitimate fear?

The answer is of course. We can’t be spending 17.5 percent of our gross national product on health care and allow everybody to broker his or her own health care. So ultimately there are going to have to be trade-offs made. The public’s going to have to make them. The delivery systems are going to have to make them. Absolutely there are going to be limitations.