Study Identifies Four Major Challenges to ACO Development

A recent study by the National Institute of Health Care Reform identifies four universal challenges in developing accountable care organizations.

The study examined seven healthcare organizations that are involved in efforts to improve care coordination and quality, all of which are key activities pursued by ACOs. The seven organizations examined include: Billings (Mont.) Clinic; Carilion Clinic, Roanoke, Va.; Physician Health Partners, Denver; ProHealth Physicians, Farmington, Conn.; Sharp HealthCare, San Diego; UniNet, Omaha, Neb.; and Westshore Family Medicine/Mercy Health Partners, Muskegon, Mich.

While each organization faced different challenges in developing infrastructure for coordinated care delivery, the study indentified four challenges that were "nearly universal."

1. Funding and the business case for change.
ACO-like improvements require substantial investment in both time and money that may not be reimbursed directly, according to the study. While increased payments to ACOs and medical homes could create a business case for these activities, financial rewards from these investments may "not materialize for a long time, if ever."

2. Resistance to change. Staff members are resistant to assuming new responsibilities or delegating work they use to perform. In some cases, the organizations faced challenges in recruiting and training employees with the appropriate skills for these roles.

3. Potential disruptions to productivity.
According to the study, "many of the care-delivery and infrastructure improvements [such as EMR and patient registries] required changes in workflow that affected productivity of clinical and administrative staff.

4. Limited infrastructure to pursue change. Efforts to improve care coordination and delivery require a great deal of accurate data, which presents a fourth challenge to ACOs. Organizations in the study noted inaccurate data inhibits population management and financial incentives for health improvement. Organizations also mentioned concerns about sharing patient data under privacy regulations.

Read the NIHCR report on accountable care organizations (pdf).

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