Treating hypertension and hyperlipidemia in an emerging Accountable Care Organization: physicians’ perspectives on health information technology, financial incentives and the patient-doctor relationship

Abstract

Rationale, aims, and objective: Accountable care organizations (ACOs) in the United States will employ health information technology, multidisciplinary care teams and financial incentives to achieve treatment goals for chronic conditions, such as hypertension and hyperlipidemia.  Whether these approaches will enable physicians and patients to overcome barriers to achieving guideline-recommended care is unknown.  We sought to characterize the potential roles of health information technology, multidisciplinary teams and financial incentives in achieving treatment goals for hypertension and hyperlipidemia in an emerging ACO.Methods: We conducted in-depth interviews with 20 primary care physicians (internal medicine or family medicine in an integrated network of independent community-based physician practices in the Greater Boston (Massachusetts) area. We used the immersion-crystallization approach to content analysis.Results: Physicians indicated that the most significant barriers to achieving treatment goals lie in the patient domain, rather than in those involving physician practice. The patient-physician relationship was cited as extremely influential in achieving treatment goals emphasizing the importance of a key component of person-centered medicine in this context. Health information technology and multi-disciplinary care (e.g., involving nurse practitioners) play supporting roles. Current financial incentives seem not to influence physicians’ management of these conditions.  Physicians generally agreed, albeit with some reservation, that electronic health records and computerized clinical decision support could support efforts to treat hypertension and hyperlipidemia; nonetheless, these physicians consistently reiterated the importance of a person-centered relationship with patients as a strong determinant of successful treatment.Conclusions: As ACOs emerge and organizations invest heavily in health information technology, multi-disciplinary care provision and financial incentives, it is essential that they also seize the opportunity to nurture patient-physician relationships in direct recognition of the importance of person-centered care in the optimization of clinical outcomes.