John Harris, principal with the consulting firm of DGA Partners, describes the eight key areas that organizations must develop in an ACO infrastructure.
There is a certain amount of infrastructure that youíll need in order to have an ACO. Some organizations already have some of this infrastructure in place. Physician groups may have it in their practice; some IPAs or PHOs may have it already for other contracts. There are eight key areas that you need to cover.
First of all, you will need leadership and vision. You need to be sure that you understand this initiative and that you are committed to succeed in an ACO environment. This is not something that can be done easily as a side venture. The leadership of the organization needs to be involved and committed. You need an engaged provider network, effective management based on evidence-based medicine and a chronic care focus given the population youíll be taking care of under Medicare. You need financial and analytic capabilities and the IT infrastructure and reporting that support those. You need administrative infrastructure, and you need capital to fund development and cash flow as you are operating your ACO. And finally, if you are in a full or partial shared risk environment rather than just an upside-only environment, youíll need risk management capabilities as well.
Success in ACOs will require an enhanced role for PCPs. Many people have said that you should not even try to have an ACO unless youíre going to have a patient-centered medical home (PCMH), and Iím not sure I would be that extreme but certainly it would help. The philosophy of the PCMH and the results that they have been generating are aligned with the goals that you would try to achieve as an ACO. That is one key consideration whether and how you pursue a PCMH. If you donít pursue a PCMH, you certainly do need to pursue innovations that might fit your local communities and work well there. I work with some rural communities where PCMHs are not in the cards for them; itís not a model that works, given the relatively dispersed delivery network. However, there are other tools that theyíre interested in. Each local community must decide what will make sense for the development of the ACO.
Source: Essential Guide to Accountable Care Organizations: Challenges, Risks and Opportunities of the ACO Model, December 2010
Essential Guide to Accountable Care Organizations: Challenges, Risks and Opportunities of the ACO Model
This resource answers key questions surrounding ACOs so that hospitals, PHOs, IPAs and other physician organizations, networks or group practices can weigh the merits now of creating an ACO and complete the necessary groundwork before CMS's ACO operation date of January 2012.
Essential Guide to Accountable Care Organizations: Challenges, Risks and Opportunities of the ACO Model is available from the Healthcare Intelligence Network for $189 by visiting our Online Bookstore or by calling toll-free (888) 446-3530.