Anthony Cirillo

As healthcare reform moves from passage to implementation there are many concepts being bantered about, including the notion of accountable care organizations. These are essentially a group of healthcare providers charged with the care of a given population. Most of this has been couched in terms of multiple hospitals (which may even compete with one another currently) as well as physician practices. But the notion could also extend to long-term care.

An accountable care organization could include home health, adult medical day, DME, continuing care, assisted living and nursing homes, and hospice. The whole continuum of aging could therefore be one accountable care organization that is paid for the care of a given population outside of the hospital/physician relationship.

So this got me thinking. How in the world do you ever bring such disparate organizations together against a backdrop that includes lack of communication among providers, nurse-to-nurse hostility, and overall distrust of the system?

I had an “a-ha” moment after reading a recent New York Times article about Apple CEO Steve Jobs: He should lead healthcare reform implementation!

According to the article, Jobs doesn’t design products based on committees or market research data, but through a heavy reliance on “tenacity, patience, belief and instinct.” Jobs creates “edited products that cut through complexity, by consciously leaving things out.”

Who better to simplify resident and family experiences? Instead of an ACO, Jobs would create “Your Accountable Care Organization,” with just what you need when you need it. And that is a good thing because under reform there is a lot of room for interpretation.

There will be business as usual with organizations figuring out how to “game” the system and there will be other approaches that take the spirit of what has been put forth and look to implement new initiatives with the goal of high quality, lower cost and great resident/patient experiences.

To be sure, healthcare will probably get more complicated. And more accountable. We will be paid for performance and that means documenting that performance. As that happens we need to be wary because healthcare gets so log-jammed pouring over metrics that there truly is paralysis by analysis. That is why Jobs is our man. He steps away and puts himself in the user’s (read resident’s) head. He reaches for what people only dream about or have not even considered dreaming about.

I returned from the National Council on Aging conference somewhat dismayed too. While the conference is not necessarily about long-term care, you would have thought that it did not exist at all when listening to the speakers. Most of the topics were about aging in place and care options in the community.

I personally believe that a country ranked 37th in the World Health Organization will have people who need long-term care services, despite the medical technology, devices and pharmaceuticals that exist. Yet people seem to want to “will” the profession out of existence. So long-term care organizations need to take action by owning more of the pie.

When an organization develops complementary products and services related to its brand we marketers call them brand extensions. Given that most of the population and many of those involved in aging services want to believe that long-term care will not be needed or choose to believe it will not be needed by them, it may be smart for organizations to start thinking about their long-term PR as well as survival.

By controlling more of the continuum of care, organizations will be prepared for the implications of healthcare reform and they will be assuring the filling of their pipeline as people progress from one level of care to another. At the same time, the consistency of the brand experience over time will help develop loyalists and ambassadors for organizations that will continue to fill the pipeline for years to come. And to make this happen perhaps we need leaders who have a right to be somewhat dictatorial because their vision is so strong as not to be denied. That might actually move healthcare organizations forward faster.

And all of us need to realize that accountability starts with each and every one of us taking control of our health so we don’t need the system at all!

Anthony Cirillo, FACHE, ABC is a healthcare expert, elder advocate and expert blogger for Wellsphere in the area of aging and senior health. He works with long-term care facilities and is available for management retreats and association keynotes. He is the author of “Who Moved My Dentures? His company, Fast Forward Consulting, empowers organizations to change the healthcare experience and leverage it in their marketing. In his spare time he entertains residents in assisted living and nursing facilities. Anthony will be speaking at the annual AHCA convention in California this fall on Moving Person Centered from Theory into Action. To read more, go to and