With healthcare reform stalled, the momentum of the industry’s shift to accountable care may have slowed, but boards should not dismiss its promise. With or without national healthcare reform: 1) Medicare is projected to be bankrupt by 2017 or sooner; 2) the funding of Medicaid by many states is at risk due to budget shortfalls; 3) employers will continue to drop coverage for their employees as premiums continue to increase; and 4) payers will continue to emphasize initiatives to “bend the curve” of healthcare spending by placing the onus of demonstrating improved quality, cost savings, and value on providers. So, we can either get paid less for what we do or transform the way we deliver care.

While the future of healthcare reform is unclear, one thing is certain: hospitals and health systems must adapt to an inadequate reimbursement environment. Private and governmental payers will continue to press for accountable care as a way to control costs and improve quality. Many still believe the ACO concept holds promise, and the negotiations of the Senate bill included expansions of the idea to capitated and pediatric ACOs. It is expected that ACO initiatives will roll out on a large scale within the next four years, with emphasis on health prevention and patient engagement instead of treating sickness episodically.