Monday, July 11, 2011

The One Question That Any Board Should Ask Management About Participating As An Accountable Care Organization (ACO)

The minimum knowledge needed to get from Point A to Point B

We've all thought about the "suppose just one" questions.  For example, "suppose" you could only eat "just one" type of meal for the rest of your life, what would it be? (Disease Management Care Blog answer: pizza).  "Suppose" you had "just one" wish granted by an all powerful genie? (Answer: whatever the DMCB spouse would want).  It's not only a useful exercise in behavioral neuroeconomics and "what if" mind gaming, but it also puts things (like pizza and the pervasive influence of the DMCB spouse) into perspective. 

Well, suppose you're on the Board of Trustees or Directors for a hospital or physician provider group and you're at a "go" or "no" meeting that will decide about participating in a risk-bearing Accountable Care Organization type of arrangement.  Imagine that your Management Team, tantalized by the luster of riches, quality and cornering the local market is recommending "go."  They've done their PowerPoint presentation and the lights go up. 

Now "suppose," asks the DMCB, that you have "just one" question to ask. 

What will be that question be?  "Will this eventually lead to full risk bearing?"  Or....."What actuarial methods will be used by CMS to adjust the per member per month claims expense target?" Maybe...."Egads, haven't you read what the DMCB has written about ACOs?"

All excellent questions, but the DMCB has scoured the universe of possible queries and landed on a "just one" recommended question for Board members.  It is.....

"How will the dashboard be set up?"

The concept of a "dashboard" implies exactly what it says: an ongoing, graphic and up-to-the-minute display of the key parameters necessary for the successful operation of a vehicle that are necessary to get you to where you are going.  That dashboard question packs in a lot of issues with a marvelous economy of words, because the answer will tell you if your operations team....

1) Understands the need to have as close to "real time" data as possible, so that they can spot any adverse trends and act on them promptly;

2)  Has selected the handful of lead economic and clinical outcomes that will encompass the end-of-contract financial reconciliations;

3) Is prepared to secure and coordinate data from several sources, such as (for example) the "speedometer" of readmission rates, the "tachometer" of primary care appointment wait times and the "fuel gauge" of diabetes quality measures;

4) Will use a enterprise-wide graphic display of a small number of "lead" metrics so that everyone is on the same page;

5) Understands that actively managing to too many targets is fraught with the risk of data overload;

6) Has thought about securing the assurance from any outside parties (such as insurers) that their data feeds going into the dashboard will be accurate, complete and timely.

7) regularly reads the DMCB.

If you get blank looks to that "just one" question, the next answer should probably not be "go," but "no."

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