In case you’ve been hiding out in some comfy cozy cave recently and have missed the conversation about ACOs (Accountable Care Organizations), it’s time to shine a spotlight on what these new entities might mean for your physician career.
I want to begin with a disclaimer – this is not my area of expertise. Rather it’s my area of great interest at present, as I sense the foundations of medical practice as we know it begin to shift. An earthquake is an unfortunate metaphor present, so maybe I’ll stick with a tremor.
Simply, the term ACO evolved from the Medicare Shared Savings program (part of the recent healthcare reform Patient Protection and Affordable Care Act) and refers to a legal entity under whose governance comprehensive longitudinal medical care is coordinated and delivered to its recipients. If this coordination of high quality care results in cost savings to the insurer, these savings will then be shared with the ACO, and hopefully land up in the pockets of the “providers” (physicians, hospitals, allied health professionals, and other health service providers).
The originators of the concept have defined three core principles for ACOs:
1) Provider-led organizations have a strong base of primary care that are collectively accountable for quality and total per capita costs across the full continuum of care for a population of patients;
2) Payments are linked to quality improvements that also reduce overall costs;
3) Reliable and progressively more sophisticated performance measurement are in place to support improvement and provide confidence that savings are achieved through improvements in care.
Much of the success of an ACO will depend on having the following place:
- physicians who understand their roles in delivering “accountable care” — and understand what it means to be truly accountable to their team and their organization
- physician extenders who can deliver the kind of routine and preventive care that doesn’t require an MD or years of specialization
- healthcare team members with a commanding knowledge of health behavior change and how to coach their patients to measurable healthier outcomes
- physicians with a team-oriented mentality
- physicians with excellent team leadership training and skills, including strategic thinking, excellent listening and interpersonal communication skills, the ability to persuade and influence peers and others, and analyze, understand and synthesize data into meaningful information and knowledge
- excellent communication and collaboration between medical staffs or groups and their hospital administrators
- health information technology that captures patient information accurately and that can be sliced and diced in a million different ways to yield insights into how to deliver excellent care at a population-based level
- healthcare information technology that facilitates appropriate “point of care” decision-making
- collaborative rather than adversarial relationships with third-party payers, who are also incentivized to deliver appropriate care
- Satisfied ACO “members” (patients) who have confidence in their providers and are willing to stay within the system and not use their “Medicare clout” to seek care elsewhere, at a cost to the ACO (who is now assuming financial responsibility for paying for that care)
My physician-centric belief is that the real success of ACOs will hinge on:
- reigniting the passion most doctors felt for practicing medicine back in medical school, to prevent them from jumping ship into concierge medical practices (depending entirely on direct patient payments) or out of clinical practice altogether.
- developing robust pathways for interested physicians to acquire the new skills of leadership, strategic thinking, team-building, data analysis and interpretation, quality and performance improvement, peer performance management, the integration of clinical decision support and technology, innovation in clinical delivery and practice design, systems design, technology evaluation and review, financial modeling — there’s a long list here! And then to bring them to the table as valued and valuable participants.
- training hospital employees, physicians, other care providers and their office staffs in the art of Customer Satisfaction a la Ritz Carlton
And these are some of the up-and-coming roles I envision for doctors dreaming of career change or evolution and hoping to capitalize on the ACO movement:
- team director/leader
- service line medical director/administrator
- quality and performance improvement specialist
- patient safety specialist
- internal medical communications expert
- systems designer
- innovative practice/virtual healthcare delivery designers
- leaders of health coaching teams
- health coaching program content creators
- clinical decision support specialists
- health information systems specialists
- practice management consultants
- healthcare consultants of many shapes and varieties
- physician executive coaches
The time is now. And the field is wide open for physicians with a creative, entrepreneurial or leadership drive.
What opportunities are you spotting?
PS: Additional articles on ACOs include: