5 lessons for integrating specialty care into ACOs

Integrating specialty care into accountable care organizations can significantly contribute to high performance and financial success. However, doing so smoothly and effectively could be challenging for many ACOs.

To clarify the challenges and opportunities for ACOs integrating specialists, Health Affairs consulted with eight healthcare leaders during the summer and fall of 2015. Respondents included one CEO, one president, three vice presidents, two medical directions and one partner from organizations across the country who are currently working in value-based arrangements.

Here are five lessons for integrating specialists into accountable care based on the respondents' experiences, according to Health Affairs' blog.

1. Focus on both indirect and direct improvement. ACOs are directing the majority of their focus on influencing primary care referrals and patient behavior during the beginning phases of specialty care integration. Most respondents indicated they are focused on influencing referral patterns for specialty care by encouraging PCPs to only refer to specialists when it is truly necessary. In these cases, PCPs seek specialists whose practices have demonstrated the consistent ability to keep costs low.

Some ACOs are also focusing on using care management programs to guide patients in their utilization of specialty care for follow-up services. This could be an especially effective strategy for ACOs participating in Medicare, where patients can self-refer to any physician, according to the report.

2. Include PCPs in process redesign. Respondents described various tactics for engaging physicians in process redesign for integrating specialists. One ACO said it sends quarterly reports to its PCPs and holds periodic meetings to address issues and identify gaps. Another said it holds private discussions with PCPs in addition to larger meetings. A third ACO recommended involving representatives from various departments, such as finance, IT and analytics so the leadership can hear insight and feedback from different perspectives, according to the report. 

3. Start small. The ACOs interviewed by Health Affairs have started off by targeting healthcare conditions where there is greater likelihood for early success — those where care pathways are already established, accountability is clear and where cost or quality concerns already exist. Conditions characterized by high rates of hospitalization and readmission are most common targets, such as cardiology and orthopedics. Some ACOs are focusing on areas where employers are interested in savings, according to the report.

Using a pilot approach allows teams to identify organizational nuances and work out any unexpected issues before implementing an approach across the whole system. As physicians begin to see positive outcomes, such efforts will build momentum and will be easier to expand to other areas and conditions.

4. Leverage data. Respondents told Health Affairs they are first collecting data on the total rates and levels of service use for a few conditions, and identifying outliers, inconsistencies and gaps. Sharing this information with physicians has motivated them to determine the sources of differences.

5. Approach the next phase with caution. ACOs are slowly and carefully moving toward linking specialty care performance to risk, payment and incentives, according to the report. However, before tying payments to outcomes, ACOs must engage specialists in the care delivery improvement process, as well as population health.


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