To date, 32 organizations across the country are participating in the Pioneer ACO initiative, hoping to inspire others in their regions to follow suit. As the benefits of adopting this model become clear, more organizations are looking to explore the possibility of becoming an ACO.
Ron Parton, MD, chief medial officer at health IT firm Symphony Corporation, outlines seven critical success factors for ACOs.
1. Align the payment model with value. The key for organizations to be successful in these types of new payment arrangements, said Parton, is to make sure they have the payment arrangements in place as they change their care delivery models. "There are organizations and integrated systems around the country that have introduced their quality improvement programs before entering into a shared risk arrangements, and [they] have improved quality significantly but have lost revenue because they reduced fee for service business," he said. "So one of the keys is to try to make sure you're matching your payment model with your quality improvement efforts so you don't get ahead of yourself." And once you've created that type of payment model, Parton added – whether it's participating in a Medicare shared risk arrangement, or a local or national insurance company that's creating a pay-for-performance or a shared risk opportunity – it becomes a question of investing in the right type of infrastructure.
2. Pay attention to leadership and cultural change. According to Parton, one of the most pressing things to understand when changing payment models is that specialty physicians, in particular, may struggle with understand the importance of these new arrangements, since most have depended on fee-for-service to be successful through their careers. "So, it's important to pick leaders who are forward-thinking and who will support the new care payment arrangements," said Parton. These selected individuals can help lead initiatives across the medical staff. "Once you get some of the medical staff bought in, it's important to invest in infrastructure that helps them be successful in the new model," he said.
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3. Hire experienced health professionals, especially nurses and health coaches. Part of driving cultural change, said Parton, is to hire staff to help make these new initiatives successful. "One of the key factors of all this work is to identify complex patients who have difficulty navigating the system, managing their own illness, taking medications, etc.," he said. "The professionals who have skill sets to change that behavior may be different than what current integrated systems have hired." Identifying nurses who understand how to implement specific techniques and help patient manage their illness can drive the transition more quickly, said Parton, therefore making it essential to have these types of staff members on board.
4. Take the time to gain buy in from the primary care practitioners and their staff. Naturally, there will be practices that are resistant to change, said Parton, so make sure you touch base with every practice and have a contact and leader in each to help educate and lead their group. "This is extremely important, otherwise, people will give lip service but they won't change their workflow of how they're managing their practice day to day," he said. He added that a lot of the work doesn't need to be done by physicians, but by associated in their offices, like nurses, medical assistants, nutritionists, etc. "Getting that buy-in across the entire staff of a practice is important," he said. "It's not just the practitioners." Keep in mind the role EHRs will play in the transition, Patron added, especially when it comes to adding more work to learning the new IT system. "Doing this work for an ACO is additional stress," he said. "So helping them understand some techniques, some new tools they can use to improve their work is part of the issue."
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5. Develop the data model, IT infrastructure, and tools to support reporting and analytics. One key piece for larger organizations, said Parton, is getting all organizations involved in the transition on the same page. "There are multiple organizations involved, and they come together to do the shares risk arrangement," he said. "So they may be on multiple systems and multiple data sources, and one of the challenges upfront is integrating and taking data from all those sources into one common data warehouse." The first step, he added, is to identify who's participating in the ACO and what the differences are in their data infrastructures. The next step is to create interfaces with each separate data source to do mapping. "That's where the data model comes in," he said. "You need to make sure you understand the differences in data from one entity to the next … all that detail is extremely important." The last step, said Parton, is pulling the data and integrating it into a common platform, "so if you invest in that, you have the data to do any of the programs, projects, or measurements, and it makes your life so much easier if you do all that upfront."
6. Invest in a population health and care management system, and integrate with the EHR. A population care management system allows you to take data from all your sources and use it specifically to track and manage subpopulations, said Parton. "You want to target and allow care teams to do follow-up work with care plans, " he said. "The population care management system can be the common care plan platform that allows professionals to track and manage patients across the system... care is coordinated in a way that helps people stay out of the ER and out of the hospital." In turn, the system takes nightly feed of EHR data and makes it available to care teams, allowing them to determine gaps in care by seeing the care across an entire population. "Whether they're following evidence-based guidelines and are looking for patterns of someone not taking medication, or they have multiple doctors managing care and it's uncoordinated, they can look for that pattern," said Parton. "They can target the right patient and give them the care they need."
7. Match the organizational readiness for change. "All the things an ACO needs to do simultaneously, it's a lot of work and a lot of change for an organization," said Parton. "It's important for the organization to continuously monitor how well these initiatives are going on a daily or weekly basis and make sure you're not getting ahead of yourself." Constant communication and listening, Parton continued, in terms of feedback from physicians is key. "At some point, you may find you have to step on the brakes for a bit because you have to wait for your IT team to catch up," he said. "Or, from a payment model perspective, you have the model in place and need to accelerate those results-oriented projects because you need results from the bottom line sooner. It's about stepping on the brake or the gas to make sure things are moving."