ACOs Must Think Globally, Act Locally
Of course, what works in California may not work elsewhere. Use cases for the ACO model can't be viewed as academic exercises in data, according to Kenneth Paulus, CEO at Allina Health, a health network providing care for roughly one-third of Minnesotans. (Paulus spoke on the ACO panel at the recent MIT Innovations in Healthcare Conference.) "It's messy, difficult and personal," he says. "A lot of times, it's not about data."
Nor will what worked for early adopters work on scale. ACOs must strike a balance between needing data to adjust services as they manage overall cost growth and, at the same time, continuing to adapt their practice to local cultures, says Dana Gelb Safran, senior vice president of performance measurement and improvement for Blue Cross Blue Shield of Massachusetts. Crucially, data on patient experience lies at the heart of the matter.
To that end, Allina uses care guides, health coaches, triage nurses and other "creative positions" to ease the burden on physicians while improving patient engagement, Paulus says. Care guides, in particular, play an important role; working with three or four doctors, they serve as a go-between for patients with chronic conditions and their physicians. "They are the glue to the practice," he says.
Involving these various front-line caregivers is paramount to the success of the ACO's redesigned care delivery mode, says David Torchiana, chairman and CEO of the Massachusetts General Physicians Organization. Hospital leadership can't just simply hand down a set of guidelines and expect caregivers to comply.
Massachusetts admittedly has had a head start on other states, Torchiana admits. Pioneer ACO Partners HealthCare has been a de facto ACO since the early 1990s, while cost management and risk-based contracts have been on executive's minds since the state's landmark 2006 healthcare reform bill. If the Bay State is any indication, Torchiana says, "The signs are very encouraging."
ACO Success Hinges on 'Mindset Shift'
Despite the hurdles, and despite the setbacks the Pioneer ACO Model endured in 2013, there are six reasons that the MIT speakers say the ACO will fare better than the HMO:
In particular, Safran says, the cognitive, motivational, practical and financial barriers to a patient's ability to take a physician's advice are falling. When physicians aren't rated, or compensated, based on outcomes, it's easy to adopt a "don't ask, don't tell" policy - payment reform, she says, tells physicians that they need to me "practicing at the top of your license."
Above all, though, the success of the ACO model rides on what Gluck calls a "mindset shift." When a worried mom calls a doctor's office at 4:30 p.m. on a Friday, a physician who bears no burden to save costs can tell the mother to take her child to the hospital to treat a fever. When there's a shared risk, though, the physician will make time to see the child - and, Gluck says, earn $12,000 or more in shared savings for the entire organization by eliminating a single hospital visit.
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