3 Suggestions to Intensify Specialist ACO Involvement

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Most accountable care organizations, regardless of if they are formed by hospitals, health systems or physician groups, are primary-care based. After all, patients are generally attributed to ACOs based on their primary care provider.

However, specialists can — and must — play a role in ACOs for the model to succeed, according to a Harvard Business Review blog post written by John Peabody, MD, PhD, founder and president of QURE Healthcare, a company that measures clinical practice and assesses economic value for organizations working to improve healthcare, and Xiaoyan Huang, MD, an attending cardiologist at Providence Heart Clinic in Portland, Ore.

"Managing the cost risks cannot be delegated to primary care providers alone. Any innovative care redesign must include all providers and cannot pit generalists against specialists," the authors wrote. Primary care physicians and specialists must work together: Primary care providers need to screen patients critically to identify who needs targeted treatments from a specialist and who does not so specialists do not become overused; and specialists need to be held accountable for their spend.

The authors offered three suggestions for ACOs to better integrate specialists.

1. Develop better partnerships between primary care physicians and specialists. This can be fostered through electronic health records, health information technology and physician leaders who are trained in health economics, data analysis and project execution, according to the authors.

2. Use proper metrics. The metrics should be case-mix-adjusted and measure value by determining if the right thing is done at the right time. Feedback on metrics is also important, as it fosters continuous learning, according to the article.

3. Adopt broad disease-based spending targets. Disease-based spending targets divides the total cost of care between primary care providers and the specialists who treat patients with a given condition or episodic disease.

"A system that holds primary care and specialty providers jointly accountable for cost and quality remains critical to American healthcare," the authors concluded.

More Articles on Accountable Care Organizations:
Physicians as Full ACO Partners: The Ideal Model?
3 Reasons ACO Growth Has Slowed
9 ACO Implementation Challenges

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