“10-to-Win” Traits in Accountable Care | Part 2

Date: 05.15.2013 | Zach Urbina">Zach Urbina


Since the first half of this blog was published two weeks ago, many articles hypothesizing the failure of ACOs have appeared in the trade and mainstream media.

Dire predictions about innovative ideas are not new. Nearly 18 years ago to the day, Newsweek published an article—“The Internet: Bah”—predicting a cataclysmic end to this newfangled way of communicating. But something changed. The architecture supporting the internet has become more usable, stable and better each day as it has been understood and consumed.

And guess what: ACOs by design will track that path of improvement, too.  ACOs are forcing relationship reinvention and realignment between the payer and provider. Healthcare’s renaissance to value-based care is inevitable and ACO’s fluid form will help fuel the transformation. The next five of the “10-to-Win” Traits in Accountable Care are no less important than the previous five and all call for innovations to turn critical thought into creative actions.

Provider engagement. A combination of strategies must be deployed to gain critical mass. Strategies should center upon physician satisfaction, change management and shared value. Driving physician engagement means shifting risk to providers—enabling them to think like a health plan with tools and transparency into costs of both episodic care and the total cost of care. Last year I had dinner with Dr. Denis Cortese, CEO Emeritus of Mayo Clinic. I asked him, “How do you change behavior of a salaried physician?” Without hesitation, he told me “The square root of n. You take the number of physicians, calculate the square root of that number and those are your champions of change. They do the right thing and the others will fast follow or will fall off.” He advised organizations should not underestimate the natural leadership qualities of physician champions.

Member engagement. Great ACOs will take the next step where patients are more than satisfied, while simultaneously set subtle hooks. Creating non-intrusive engagement campaigns will be vital.  The day is not far off when, if an individual orders a large-print book on Amazon, the care team is alerted so an optometrist can reach out to the patient. Imagine the possibilities of recording elevated temperature, blood pressure or maybe a blood sugar spike during a phone call and then attaching them automatically to the patient health record. Computers and software need to be designed to acclimate to human life within HIPAA regulations. The result may be a very positive and will enable the patient to share in accountability for their health. This is the only industry where the consumers are more tech savvy than their retailers, but this will correct itself over time. Enabling patients to actively process information, decide how that information fits into their lives, and act on those decisions is a key driver to improving care and reducing costs associated with preventable diseases. Savvy organizations likewise should take care not to underestimate the blended co-pay and deductible structures as an intricate part of placing shared accountability on the patient.

Value-based contracting. To gain optimal outcomes in value-based based contracting, organizations must understand the path to accountability and assess where they are today. When writing an accountable care contract, it is important to encourage realistic, ongoing improvement in cost and quality outcomes based on the information gathered. All successful accountable care contracts share certain characteristics in this regard, including:

  • Motivation for a deliberate, forward flow from Fee-for-service to full capitation
  • Incentives for bi-directional information sharing
  • Stipend for specific behaviors that seize the low ground

Point-of-thought decision support. These are the magic moments of health care. A living patient record with the latest information available is paramount, providing guidance for current evidence-based decisions and presenting live statistics, but also allowing for freedom so the provider can practice the art of medicine.  For providers to start thinking like a health plan, the payers need to teach providers how to consume and act on information from their experience.

Care-team coordination. The currency of care team coordination will be enterprise workflow optimization.  The architecture of how the “medical neighborhood” must lend itself for peer-to-peer communication and enable the expert voice of each clinical extender. Boundless care platforms with member and care provider portals will be the vehicle to drive team care, but all team members must commit to its use.

CJ Fulton is the Director of ACO and Government Consulting for ZeOmega.  He brings over 17 years of diversified international experience in HIT, population health design, and innovating new health care models for payers, providers and value-based care organizations. ZeOmega plans to be at HIMSS, Booth #6252.

Related Post

Leave a Comment

Name (required)
Your Message (required)