Can Accountable Care Succeed without Accountable Patients?

The movement towards accountable care is focused on making all providers "accountable" for the health status of their patients throughout the healthcare delivery system. Many of the guidelines for patient treatment revolve around physicians and other providers following "best practices", which have been established to provide the best combination of care and cost effectiveness for the overall population.

But what if the patients themselves are not willing to be accountable? What if they're not willing to follow best practices? A recent Health Affairs blog entitled Bringing Patients Into Health System Change highlighted recent studies in which patients intentionally disregarded evidence-based best practices and their own physicians’ advice, sometimes labeling them "stupid" or "dumb". Wariness of the prescription drug industry causes patients to refuse to fill prescriptions, or fill those prescriptions but not take the medications – but not report their reservations to their doctors.

This issue is partially, although not directly, addressed in another Health Affairs blog entitled The New Imperative Of Patient Engagement For Hospitals And Health Systems which stresses the need to engage patients on health literacy issues and the proper processes improve their own healthcare treatment effectiveness. 

Since patients have the ultimate choice in the care they receive, can accountable care succeed without patient buy-in? Will the best efforts of physicians and other healthcare practitioners to follow evidence-based guidelines fail because of refusal of patients to accept them? It will be interesting to follow this issue over the next few years.