Preparing for Accountable Care Organizations: A Physician Primer

doi:10.1378/chest.12-2299

Chest

Volume 143, Issue 4, April 2013, Pages 1140-1144

https://doi.org/10.1378/chest.12-2299 Get rights and content

The concept of the accountable care organization (ACO) offers the opportunity to better integrate the health system into a value proposition aligned toward improved care, more efficient delivery, and higher patient satisfaction. As a significant component of health reform, the ACO has many implications for physicians. Physicians interested in joining ACOs have a variety of options, including forming their own, integrating (virtual or otherwise) with larger health systems, or joining multiple, existing ACOs. To succeed, fundamental changes away from the past fee-for-service model will be necessary. Clinical and financial data will become of paramount importance. The data will need to be more accessible, more accurate, and more appropriately used to align with the greater ACO value proposition. Physicians will also need to embrace the “era of persuasion” with its underlying assumption that engaging patients and other physicians are as necessary as a proper diagnosis and treatment plan. As there is a wide array of options in the marketplace, providers must have a clear understanding of patient attribution, financial incentives, and quality metrics within any ACO agreement. Finally, the health-care system must acknowledge the difficulties associated with the pace of change itself and invest in resources to aid in the adaptive reserve of all components of the health-care system.

Section snippets

Who Should Create ACOs?

Accountability across the spectrum of care begs the question of which of the various participants in the health-care arena should create an ACO. Literature has focused on the capacities of physicians, hospitals, and health plans to effectively form and manage ACOs.3, 4 Given their subject expertise and role as the primary deliverers of care, physician groups would seem well positioned to provide leadership in health-care quality and efficiency. However, there are extensive hurdles to realizing

What Should Physicians Expect in an ACO?

For many physicians, the ACO environment will be a dramatic departure from their current practice style. Physicians will find reimbursement increasingly linked to nonproduction metrics, the ability to engage in complex data resources, and the ability to influence others' behavior (ie, patients and other physicians).

Any discussion of revenue from savings and efficiency reminds many physicians of the managed care organizations (MCOs) of the 1990s. While there are significant similarities between

ACO Payments to Providers

Physicians engaging with ACOs will need to better understand the fundamentals of value-based contractual obligations and relationships. The CMS-MSSP model ties the ability to access generated savings with meeting specific, clinical, performance metrics. Unfortunately, it is our experience that there is a myriad of such metrics in the marketplace, seemingly a different set for each payer. Suffice it to say that providers should be aware of the specific definitions, sources, and methodologies of

Adapting to Change

With such dynamic changes approaching health care, perhaps the greatest challenge will be change management itself. The hurdles associated with continuous change were highlighted during the American Academy of Family Physicians' National Demonstration Project, launched in 2006 by selecting a national sample of practices to test a comprehensive PCMH model.¹⁷ The Project demonstrated that while transforming practices into PCMHs is feasible, it requires a high level of effort, and sustaining such

Conclusions

The ACO offers the opportunity to better integrate the health system into a value proposition aligned toward improved care, more efficient delivery, and higher satisfaction. To succeed, fundamental changes away from the past fee-for-service model will be necessary. Clinical and financial data will become of paramount importance. The data will need to be more accessible, more accurate, and more appropriately used to align with the greater ACO value proposition. Just as important, providers must

Acknowledgments

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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Topics in Practice ManagementPreparing for Accountable Care Organizations: A Physician Primer

Section snippets

Who Should Create ACOs?

What Should Physicians Expect in an ACO?

ACO Payments to Providers

Adapting to Change

Conclusions

Acknowledgments

Creating accountable care organizations: the extended hospital medical staff

Health Aff (Millwood)

American College of Physicians website

Physicians versus hospitals as leaders of accountable care organizations

N Engl J Med

If accountable care organizations are the answer, who should create them?

JAMA

Centers for Medicare & Medicaid Services website

Turning doctors into leaders

Harv Bus Rev

Why accountable care organizations are not 1990s managed care redux

JAMA

Lessons that patient-centered medical homes can learn from the mistakes of HMOs

Ann Intern Med

Topics in Practice Management
Preparing for Accountable Care Organizations: A Physician Primer