The move to Accountable Care Organizations (ACOs) disrupts the previous relationships and long held practices of providing healthcare.
Physicians must learn how to measure performance, use patient outcome data and improve their performance, and ensure they meet all the requirements necessary to maintain revenues.
ACOs also affect another area some may not realize quite yet – physician-determined referrals to specialists. The changes will disrupt both physician and specialist practices.
Most physicians have referred their patients to the best specialists they know. They have used their own judgement while considering feedback from colleagues and patients. Under the new rules, however, physicians may not be able to depend on the specialists with whom they've developed relationships, because there are economics at stake.
The introduction of risk, requires them to rely on performance-based data to make their determination, but even that may not be enough. Since many physicians are now in employed groups, they may no longer have much say in which specialists they refer their patients.
In order for physicians to maintain their ability to recommend the specialists they trust, a process must be created which results in a unified vision for the ACO. A few foundational principles for the process follow:
- Encourage primary and specialty physicians to collaborate in outcomes improvement. Without their collaboration, the opportunity for improvement is lost. The absolute outcome results, while important, are likely to be less important than active engagement by primary and specialty physicians in determining the causes of unexpected good or poor results. This collaboration will only become more important in outcome improvement processes that CMS will be expecting in the future.
- Foster physician engagement in collection and measurement of data. Physicians must contribute to the data; it's no longer simply an administrative task. They have to be involved in the process of reviewing and measuring the data in order for it to be accepted.
- Derive deeper explanations from data. Since the patient population impacts the results, digging into the data may result in outcomes which are potentially unfair. Marks for employed and independent specialists might be very different, so it very well may be incorrect to label one group as performing worse than others, making the results unfair.
It's no longer enough for physicians and specialists to only do basic quality reporting for Medicare or commercial insures in order to protect their revenue streams. They must have better performance than other providers. Data-driven healthcare results set them apart from their competition which is essential for survival in the Value-Based Healthcare system, especially when it comes to specialist referrals.
Theresa Hush is a healthcare strategist and change expert with experience across the healthcare spectrum. Her many accomplishments in the public, non-profit and private sectors include leading the transformation of Blue Cross Blue Shield regulations in Illinois, improving access to care as Director of the Illinois Medicaid program, and serving in executive leadership for both private payers and physician organizations. An expert at creating consensus for desired change through education and collaboration, Terry helps organizations take actions that will direct their future through meaningful technology and programs.