In 2005, a patient we'll call Don was diagnosed with an advanced oral cancer. He received a grim prognosis citing “immediate surgery” as the best option, even though it would have rendered Don unable to speak. Don sought a second opinion at Mayo Clinic, where a team of three cancer specialists met with him. They recommended radiation and chemotherapy but not surgery. Don and his wife temporarily moved 1,000 miles to Rochester, Minnesota, where he endured three tough months of treatment at Mayo. Today, Don is cancer free; he returns to his original Mayo team for annual checkups.
Don had access to high-quality, efficient care, the main goal envisioned for accountable care organizations (ACOs). Often lost in discussions of healthcare reform and the ACO concept is the most serious disease afflicting American healthcare: fragmentation. Many intractable problems related to quality, access, and cost result from the walls—physical and otherwise—separating medical organizations, specialties, departments, buildings, and payment systems. The antidote to fragmentation is integration—not the kind born of mergers and acquisitions but the type that results from teamwork that leverages experience, information, and technology to provide value for the patient.