ACO guide - Improving chronic care through medication management to unlock Medicare Shared Savings

Part 2 – Building the ACO MSSP framework: Getting and keeping the team onboard

After carefully selecting your ACO track and the associated metrics by which your success (and shared savings) will be measured, the next most important determination an ACO can make involves your clinic partners. As we mentioned in part 1 of this series: the right clinical partners are defined more so by remit than role. The vast majority of ACOs are made up of a network of individual clinics which are structured differently. While a job title may be the same from one clinic to the next, the actual day-to-day activities of individuals in that role likely couldn’t be more disparate. Said in another way, ACOs have different clinics with different people working in different ways around a different program towards a shared goal. Unlocking shared savings through the MSSP model will not be easy.

Why is moving to a new healthcare delivery model so hard? Culture eats strategy for breakfast.
Shared savings programs introduce a new model requiring a fundamentally different practice approach. While clinicians are not opposed to this new model, they must adapt quickly in order implement and evolve the program so as not to disrupt their current practice. Active collaboration between the ACO and partner clinics to discuss, understand and agree upon program expectations is key to building a successful program. Perhaps more important is making sure that your program starts by engaging the right people at the right clinic sites at the right time. The graphic below is highly applicable to new delivery model rollouts in the healthcare sector. Identifying and engaging innovators and early adopters is crucial during the new program’s rollout. Their support will be needed in order to demonstrate and communicate early success and obtain the requisite buy-in from more pragmatic providers that will be required for long-term program expansion.

You need innovators and early adopters on your team.
Your provider partners most likely to experience initial success demonstrate three key attributes: perspective, persistence and passion. In addition, provider partners likely to act as effective innovators and early adopters are more likely to look beyond their industry and own experiences for inspiration in developing healthcare models to deliver increased value.

Maintaining the status quo has already put too many clinics and hospitals out of business. Your primary contact at the clinic level should believe that failure to improve patient outcomes while reducing costs is a very real threat to both their organization and to their patients who would struggle to find, and pay for, care should the clinic cease to exist. Clinical innovators experience short-term gratification in experimentation and an ability to see and positively affect measurable outcomes. This drive to experiment and test new approaches is a critical attribute because the financial reward of unlocking shared savings is not an immediate gratification prospect.

Doing the right thing for each patient, especially in terms of support during the days when the patient is not in the clinic, is a quality that differentiates ACO clinical partners likely to unlock shared savings. Your clinician partners should be mission driven by the belief that outcomes happen one patient at a time. Successful clinician partners will not be influenced by the vocal majority who are guided by the urgency of the day-to-day.

Change in healthcare occurs at a less than glacial pace. The innovator or early adopter clinical representative with the closest ties to the parent ACO should balance the importance of the need for change with the urgency of demonstrable results that are incremental in nature and that serve to encourage other, early- and late-majority practitioners.

Who’s on the team and what positions are they playing?
The ACO-level leader
Let’s use a professional football team analogy. The ACO’s role is like the team’s front office staff, including the general manager and the owner. As the ACO representative, you’re not on the field of play, but you do provide the resources and talent required to stack the odds for success. You will also make difficult decisions regarding performance and the timing on letting poorly performing coaches and players go.

The clinician champions
These are the teams’ head coaches. They are accountable to everyone: the ACO’s general manager and owners, as well as the players (their own clinical staff and patients) who rely on them to improve their performance by generating measurable, winning results. Clinician champions write and execute the playbook in a way that generates the highest levels of performance from the players on the field: both clinical staff and patients. At the same time, they take a ‘season-long,’ goal-driven view of their practices.

It’s well-known that special teams are one-third of the game. These teams tend to be overlooked until a touchdown evens the score and an extra point is needed to clinch the win.

In our experience, ACOs and their clinics seek specialized support in two significant areas: practice management and patient management. Examples of specialized services for practice management include: population health tools, billing and coding tools, EMRs etc. Patient management tools include care management, social services and support (think dieticians for your diabetic population), medication management and patient support services.

Great special team partners should set shared expectations with the clinician head coaches and the ACO front office. These same partners should independently and methodically evaluate their performance against agreed expectations, and they should demonstrate measurable value on a regular basis.

Now that you have a solid view of the team you need to build, it’s time to set the right performance expectations across the board and share the supporting communication plan. Stay tuned for part 3 in the series coming soon.

About the authors

Vickie Andros, PharmD, is Director of Clinical Services for Curant Health
Jake Caines is Senior Director of Commercial Strategy and Performance for Curant Health

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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