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.
[See also: ACOs dominate early discussion at MGMA conference.]
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.