A health system with dominant market share, a multitude of employed physicians, and financial muscle would seem to be well prepared to start an accountable care organization (ACO). But these factors are not the essential requirements for successfully implementing an ACO, reveals a new study, Measuring Progress Toward Accountable Care, released by the Commonwealth Fund.
Get ready: To measure the state of “readiness” of healthcare providers to implement the ACO model, an in-depth analysis was carried out of 59 health systems that were members of a collaborative created to support the transition to accountable care. The analysis discovered that those organizations most ready to form an ACO were strongly patient-centered and had a focus on building the capacity to deliver advanced primary care. Also, they had the capital resources to invest in infrastructure and IT capabilities that support analysis of data across patient populations.
Other signs of ACO readiness include full or partial ownership of a health plan, an existing collaboration with other health systems in the community, and positive relationships with providers in the market. Existing risk-based contracts with payers (including bundled payments and pay-for-performance arrangements) also are key, according to the study. Some “soft” elements relating to organizational culture were also important, such as change management and leadership.
To perform the analysis, a “capabilities framework” tool was designed for a model ACO. The model included six core components: a patient-centered foundation that focused on greater patient involvement in clinical decisions; a primary care medical home; a high-value network of providers that deliver quality care at an efficient price; partnerships between ACO providers and healthcare payers to create financial incentives consistent with providing high-value care; population health data management tools designed to collect, analyze, and report health services data covering the ACO’s patient population; and ACO leadership (systematic governance and administration). Using this framework, a set of “capabilities” (operational activities) was defined for each core component and then examined to measure an organization’s progress toward implementation.
The study also noted that organizations had varying patterns of developed capabilities, which suggests that no one path toward ACO development is a guarantee of success.
Guide to ACOs: The potential of the ACO model to rein in healthcare costs while improving the quality of care has been widely touted. To provide an overview of ACOs, Healthcare Intelligence Network’s Essential Guide to Accountable Care Organizations answers key questions so that hospitals, PHOs, IPAs, and other physician organizations, networks, or group practices can effectively move to the ACO model and improve profitability and market share.