Accountable Care Organizations: What’s Overlooked?

Accountable Care Organizations (ACOs) are designed to ensure all participants involved are responsible for the highest quality of patient care possible while simultaneously controlling costs. ACOs are multi-faceted, covering such areas as finance, risk contracting, incentives, care coordination, and the effective use of health information technology. Much has been written about what an ACO is meant to be, but there are some critical areas we see that are overlooked not only in the formation of an ACO but other areas like EHR implementations and Patient Centered Medical Home initiatives.

One area commonly given too little focus is an inclusive governance organization and model. What does governance mean? To many, governance means a slow, bureaucratic decision-making process that does not involve good stakeholder representation, with decisions often handed down from far away. Governance isn’t and shouldn’t be, a dirty word. When implemented properly and inclusive of all the stakeholders, governance can be a catalyst that pushes an organization to a higher level and removes roadblocks that prevent necessary change.

From our experience with large health systems that include hundreds of employed and affiliated physicians, governance must be front and center. A well-functioning governance group will properly represent all stakeholders including primary care physicians, specialties, administration, finance, legal, and technology. We have also seen highly functioning governance groups include a special focus on patient safety and patient outcomes.

An effective governance body will work together to solve complex and very personal issues in your ACO model. For example, how do we agree on which risks to take and share them properly? Who will be accountable for those risks and how will they be rewarded or penalized based on a level of success? Further, how is success defined and how will reimbursements be distributed to the right providers?

When forming a governance body, there are three primary guidelines to keep in mind:
1. Get physician participation early and often. Identifying strong physician representatives that can speak for their peers is a must.
2. Clearly define the risks that each stakeholder will be accepting and include this in the daily workflow.
3. Think about how to quickly distribute reimbursements for commendable participation. Doing so feeds continued good involvement and creates a “rolling thunder” of positive behavior.

The formation of an ACO is a seemingly daunting task that requires much planning and thought. Bringing a solid governance body together early will take considerable effort but the payoff is solving difficulties sooner in a unified manner and will ultimately pave a smoother path to success.

By Eric Zerneke, Vice President, Arcadia Solutions

Eric brings more than 18 years of sales, marketing, and business development experience in the technology product and services industries. He is a former co-founder of NetNumina Solutions and has held leadership positions at MomentumSI, MW2 Consulting, Service Integrity, and Inktomi. Eric is a graduate of the University of Wisconsin and the University of Minnesota

 

 

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