6 Early ACO Mistakes to Avoid
Creating an accountable care organization often takes months, if not years, of strategic planning before a plan is fully developed. However, even with all of that planning, some organizations still fail at various stages of the process or do not reach their full potential. Many times, that is because hospitals and health systems make the same few, critical mistakes that can derail the process.
Here, two experts share what those mistakes are, and how organizations can avoid or overcome them and achieve success as an ACO.
1. Overcomplicating initial steps in the rollout. Most hospitals and health systems rely on electronic medical records to lead the effort of forming an ACO. After all, EMR systems are a way to connect physicians, hospitals and post-acute care facilities in order to benefit the patient. However, organizations do not necessarily need an EMR system to begin the process of becoming an ACO and start striving for improved quality and patient outcomes and lower costs.
For example, if the organization's goal is to achieve consistent transitions of care, hospitals can start to work towards that goal without an integrated EMR system. "You can move information initially through phone calls, faxes and existing capabilities, just by putting new processes in place," says John Haughton, MD, chief medical information officer of Covisint, healthcare technology company. "Don't over-complicate it; separate quick, rapid-cycle trials that are followed by scaled technical connectivity."
2. Relying on overly complex IT solutions. Along with believing that EMR systems need to be the first step to becoming an ACO, some organizations tie the results of the ACO to having advanced EMR systems and the newest technology. However, a lot of the time, using simpler technology at first is better.
"It is important to make sure the outcomes and goals of the ACO are driving the definition of success…not a technical standard driving the outcome," says Dr. Haughton. "The idea should be trying to have the simplest solution possible to meet the objective of what you are doing." Then, organizations can increase the complexity as needed.
It is also important to make sure someone in the organization knows how the EMR system works, otherwise the new technology is essentially worthless. "The key is that hospitals have somebody who knows what they're doing," says Dave Gambrill, a leadership consultant and executive coach with Gambrill Communications. "You need someone on-site that is trained on how to use it."
Some hospitals are not willing to pay for a full-time professional to fill this role, but Mr. Gambrill says leaders should think of it as an investment in the future success of the ACO.
3. Lack of proper manpower. Becoming an ACO requires a lot of work from administrators and providers alike. "One of the biggest struggles I see is when smaller practices try to force the administration and added work of these [organizations] on their current staff without taking any of their other work away," says Mr. Gambrill. "I think people are being naïve if they think it can be done with their current work force."
He recommends bringing in a case manager to run the EMR system and take charge of some of the extra work that comes with forming an ACO. It is especially important for hospitals to provide extra manpower to smaller physician practices to help with the transition, because their staff is likely already stretched thin.
4. Missing key leadership buy-in. Beyond issues with technology, it is also a mistake to move forward with the ACO model of care if executives do not understand the reasoning behind integration.
If there are some hesitant leaders or executives that do not understand the transition, it can affect the attitude of the rest of the organization and the ultimate success of integration. Breakdown in communication is commonplace in these situations.
"The leadership of the organization typically does a poor job of explaining the reasoning behind the move, as well as the realities of the change in work flow for employees," says Mr. Gambrill. "A lot of it is just being clear from the top of the organization to the bottom about what the initiative is and what it is not."
Executives may also be hesitant because of the financial risks of becoming an ACO. "The hospital will have a material financial hit," says Dr. Haughton, because of the reduced readmissions that come along with the population health management aspect of ACOs. "The CFO could be not interested because the shift will impact margins and the budget of the hospital."
He recommends doing all of the financial calculations up front and making sure the executives and other leaders understand the overarching goals of becoming an ACO before going too far in the process.
5. Not seeking patient buy-in. Managing the health of the ACO's population is critical for success, but oftentimes, patients are skeptical about those initiatives. "Without proper education and public relations campaigns to explain the changes, many patients are skeptical and may see it as a money grab," says Mr. Gambrill. If patients do not understand what being part of an ACO population means, they may choose to go elsewhere for their care.
One effective campaign that Mr. Gambrill recommends is using a car maintenance analogy. Cars require periodic maintenance to keep them running well and to catch problems before they become expensive too fix. Patients can think of this new healthcare delivery model as a way to maintain their health in order to avoid a bigger problem down the road. Mr. Gambrill says this form of PR campaign has been one of the most effective he has seen.
6. Neglecting to map network leakage. Hospitals and health systems need to keep track of where their patients are going for their care, especially in today's competitive healthcare environment. Doing so can be an opportunity to gain market share from competitors and can also make up for volume decreases from the reduced amount of readmissions that comes with better population health management.
Dr. Haughton recommends using claims data from CMS or the involved commercial payor to map what is happening in the patient network and when the patients are going to competitors. "You can do some things that change the market share," he says. "A hospital could possibly place a primary care provider in a geographically convenient transportation stop between it and a competitor," he suggests.
Because ACOs are relatively new on the healthcare scene, new mistakes and best practices are sure to come along in the future. But for now, avoiding these six mistakes is a good place to start to seek success.
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