Don't Fall Back: 7 Lessons Learned From a Pioneer ACO

You don't know what you don't know — that's how the old saying goes. Fortunately, for hospitals and health systems that have yet to launch or are in the process of launching an accountable care organization, two leaders from Peoria, Ill.-based OSF HealthCare shared several lessons their organization has learned since it became one of CMS' original 32 Pioneer ACOs.

Jim Farrell, senior vice president of marketing and communications, and Tara Canty, senior vice president of governmental relations and COO of accountable care at OSF, shared their advice for other ACOs Tuesday at the Society for Healthcare Strategy and Market Development conference in Chicago.

1. Don't rush. ACOs have been one of the biggest buzz phrase in healthcare throughout the past couple of years, but hospitals and health systems must resist pressure to simply follow a trend. "It's innovative and sounds great, but ACOs are big investments for time, resources and intellectual capital. It's a tremendous amount of work," said Ms. Canty. She recommended hospitals and health systems dig to determine if the ACO relationship is right for them and "make sure you're in it for the long haul." Ms. Canty said no matter what does or doesn't happen in Congress or elsewhere, OSF is fully committed to the ACO model and believes it is the right way to care for patients.

2. Find an "owner." Someone in the organization needs to "own" the ACO, said Ms. Canty, and this is necessary for a couple reasons. "There is a lot of detail that has to be tracked and followed up on [regularly]," she said. The ACO chief will oversee these details while also maintaining focus on the ACO's mission and avoid backpedaling. "You have to have somebody with their eye on that ball," said Ms. Canty. "It is so easy to fall back to the old way of providing care. Someone has to keep the organization focused on where we're going."

3. Build teams. Hospitals and health systems must identify which teams need to buy into the ACO (patients, physicians, executives, employees, etc.) and design plans to communicate with each. As COO, Ms. Canty said her job is to train executives and management on the transition to a value-based paradigm. "The whole organization is an ACO. The whole organization has to buy in and move to the new paradigm," she said. Breaking the organization down into teams makes this challenge more manageable.

4. Have a plan. Ms. Canty said OSF had a remarkably lengthy "to-do" list before and during the launch of its Pioneer ACO. The health system knew where it wanted to go and how to measure its progress, but Ms. Canty said it's important to remember these plans are still guidelines and are not do-or-die. "It doesn't mean we haven't had to slow a few things down," she said. "But we have a destination in mind. Make sure you measure as you go to see if you are meeting your plan."

5. Tell employees before they hear about it elsewhere. Internal communications and scripting about the ACO must be a systemwide effort, consistent and executed before a public announcement is made, said Mr. Farrell. Informing OSF internally was challenging given the tight timeframe CMS allowed. "They required we not share the news until 15 minutes before [CMS] had [its] news conference," he said. "You can imagine that 15 minutes isn't enough of a window to inform 15,000 to 16,000 people." The system coordinated its messaging efforts, however, and alerted communicators and executives about a very big announcement to be made as an organization at a specific time.

In addition to time restraints, Mr. Farrell said informing stakeholders about an ACO is also difficult given the complex nature of the model. To inform internal employees, physicians (employed and independent) and Medicare beneficiaries, OSF developed extensive sets of FAQs that also doubled as scripts for employees answering the phones at OSF's call center. OSF also dedicated newsletters, blog posts and resources on its internal portal and system website to explain the ACO and how it might affect various stakeholders.

6. Alert beneficiaries, and pay attention to detail when doing so. As OSF prepared informative mailings to Medicare beneficiaries about the ACO, it struggled with a single question: Who should "sign" the letter? The system faced several options, including its chairman, CEO and those individuals overseeing the ACO, including Ms. Canty as COO. Ultimately, Mr. Farrell said the system had to identify who its senior citizen patients trust most. "It's their primary care physicians," he said.

The system moved forward and distributed the letter from OSF's medical group. Instead of a signature, the letter included a listing of all OSF primary care physicians. "This reassured patients that their doctor was on the list, and it also showed the volume of physicians available to serve them," said Mr. Farrell. The letter encouraged patients to call their physicians if they had questions about the ACO, and OSF's call center was alerted and prepared for an influx of phone calls. Ultimately, only 1.7 percent of the beneficiaries decided not to share their medical information for the ACO — a rate both Mr. Farrell and Ms. Canty find quite low. "I think the combination of providing that information to individuals was very effective," said Mr. Farrell.

7. Get to know "the family," and prepare for it to grow. Upon becoming an ACO, a health system's "family" now includes its traditional stakeholders but requires the system to know them in a new way. For instance, Mr. Farrell recommended hospitals and health systems mine patient data for patterns that will help them communicate appropriate services and engage patients. "Getting to know your patients on a deeper level allows you to better manage and coordinate their care," said Mr. Farrell.

Providers who aren't technically OSF-affiliated also became part of the network, as many ACO patients use providers who fall outside of the system. "We've looked to partner with some different social service agencies in our communities," said Mr. Farrell. For instance, one of OSF's care managers helped a patient apply for and receive a grant to have her roof fixed so she could continue buying her insulin instead of putting that prescription money toward her roof, according to Mr. Farrell.

More Articles on Pioneer ACOs:

Policy Experts: Pioneer ACO Results Show Good Potential
Committed to the Pioneer ACO Program: An Inside Look at Atrius Health ACO
How Did Individual Pioneer ACOs Fare in Their First Year?

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