ACO leader roundtable: 3 leaders on ACO difficulties, mistakes

The term "accountable care organization" was coined in 2006 by Elliott Fisher, MD, the director of the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, N.H. Since then, the ACO model has grown leaps and bounds as there are more than 520 ACOs in the nation, with the number growing each month.

Here, three leaders from well-established ACOs share difficulties they've faced and mistakes they've made to help the model's new entrants make the transition into accountable care.

Note: Responses have been edited for length and clarity.

Question: What's the most difficult part of leading an ACO?

Lynn Barr, founder of the National Rural ACO (Nevada City, Calif.): There aren't enough hours in the day and three years goes by in the blink of an eye. It is also hard to gain the trust of the physicians, who have been burned too many times and are over-burdened.

Ruth Brinkley, president and CEO of KentuckyOne Health (Louisville, Ky.): I would say it was getting the IT platform together and assembling the component parts. Most health systems probably have the component parts, but they are not assembled the way they need to be to advance an ACO.

Aric Sharp, vice president of UnityPoint Health Partners (West Des Moines, Iowa): There is a temptation to place too much emphasis on the financial mechanism of transitioning payment models. The vast proportion of time should be dedicated to clinical transformation.

Q: What's one mistake you've made as an ACO leader that others could learn from?

Lynn Barr: I wish we didn't wait until we were approved to launch the ACO. We could be three months further down the road if we launched the initiative while we were waiting for approval.

Ruth Brinkley: Getting the right data and information system was a challenge. We had a couple of false starts on that before finding the right system.

Aric Sharp: There have been times when we have focused on financial performance instead of clinical transformation.
Q: In five years, what do you think the ACO model will look like? Where do you see the model going in five years?

Lynn Barr: If we are still talking about ACO's in five years we have failed. This is a transitional model — an opportunity for us to learn and develop as centers of excellence for population health while still getting fee-for-service. Five years from now we will be aligned with our providers and our patients, providing the best possible care at the lowest cost and all of us — our hospitals, our doctors and our patients — will be reaping the rewards. We will be highly partnered with our payers - no longer adversaries but true collaborative partners.

Ruth Brinkley: My vision would be to really have started to impact some of the health issues facing our population. I would like to think that in five years we will have some full-risk contracts and managing lives and intervening on health issues a lot earlier. I would like to think we would have built a really strong care continuum. I don't think we'll be all the way there in five years, but we will be a lot further along than we are today.

Aric Sharp: We believe in five years this value-based space will lead us to a more clinically aligned model which will allow us to actively and successfully manage risk, regardless of ownership, physician employment or place along the care continuum.

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