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.
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."
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 EMR 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."
Source from Physicians Practice
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