Wednesday, August 10, 2011

Board Members: Here's An Article on Accountable Care Organizations That Your CEO May Not Want You To Know About

Hat In The Ring
In a prior post, the Disease Management Care Blog nominated one question that every hospital, clinic, IPA, medical group or health system Board of Directors should ask when it is being asked to endorse the CEO's decision to form an "Accountable Care Organization."  Well, that question and nine others have been poised by Sara Singer and Stephen Shortell in a JAMA Online Commentary titled "Implementing Accountable Care Organizations - Ten Potential Mistakes and How to Learn From Them."

Well, they're not exactly worded as questions, but the issues in this "must read" article do need to be addressed by any organization's Board that is contemplating throwing a hat in the ACO ring:

1. How well can the organization perform as a single risk bearing entity and is the ability to merge hospital and physician performance being overestimated?

2. Will the electronic health record perform as anticipated, and what is the likelihood of inadequate provider training, clinic down-time and incompatibilities between physician and hospital systems?

3. Since quality measures will impact payment, how well has the organization performed in other pay-for-performance arrangements and will the collecting, analyzing and reporting of data meet muster (this was the DMCB's primary question by the way, when it examined the issue of dashboards).

4. Are the care management protocols ready to go, and do they have the doctors' buy in?

5. What is the likelihood that all the moving parts, including the hospitals, physician groups, key specialists or other partners will play nicely when inevitable disagreements arise, like who gets the money or the blame?

6.  How has the organization embraced the strategy of patient engagement in self-care using cost-saving and variation-reducing shared decision making?

7.  Since it is the pens of specialist physicians that account for a lot of unnecessary health care costs and patients will be free to see any doctor they please, how will we identify the most cost-effective specialist physicians and how will we encourage patients to rely on them for their care?

8. Knowing that the Feds are very attentive to antitrust and Stark rules, what is being done maximize our transparency and navigate a shifting regulatory and legal environment?

9. Organizational charts are fine, but how closely is everyone really aligned in making this work?

10, Since there are a significant number of interdependencies, if the answer is "don't know" to any of the preceding nine questions, how will that impact any of the remaining questions you just yes to?

The authors end with two recommendations for "the way forward":

1. Collective leadership involving CMS and the ACOs that promote mutual learning and....

2. "....the development of a mature performance measurement system to provide rapid feedback about what works in different local environments. What is not measured cannot be managed, but what is measured must still be managed. Management and measurement hold the keys to ACO success or failure."  In other words.... a dashboard!

The DMCB would like to modestly add a third recommendation:  tapping into the expertise of a population health management organization.  These vendors understand risk, have learned the painful lessons of reporting quality measures, have evidence-based care management protocols that have passed physician scrutiny, "live and breathe" patient self-management and - since ACOs are supposed to kick off in a matter of months - they can "stand-up" infrastructure in a matter of months.

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