What ACOs should consider when building partnerships with independent physicians
The core premise of Accountable Care Organizations (ACOs) is to “assign responsibility for a population of patients to health care providers, with payments depending on the cost and quality outcomes for that population,” as described by Managed Care. Participating in an ACO is voluntary for providers; however, the Centers for Medicare & Medicaid Services (CMS) has identified savings programs in which ACOs can share.
An ACO is formed by a group of independent providers. The ACO may find, though, that it needs to find new partners to fill a gap in medical service capabilities. When building partnerships with independent physicians, an ACO should consider a number of factors. While ACOs offer incentives for quality healthcare, they must “recognize the needs of their assigned populations and work to provide comprehensive care management across the spectrum of provider types.”
Recent research published in Managed Care suggests that “ACOs need a framework for evaluating potential partners that will help risk-bearing providers establish the partnerships that will enable them to achieve their goals.” That framework includes seven “high-value” elements to look for in potential partners:
- Patient-centeredness
- A culture that emphasizes value
- Accountability
- A team-based approach
- High-functioning health information technology systems
- A quality assurance system
- Financial preparedness for value-based care
The research involved interviews with ACO representatives as well as entities representing several different types of healthcare providers. Additionally, an expert panel was convened to “evaluate the framework and help prioritize provider types to evaluate.”
Managing care appropriately and in line with the move toward value-based care requires coordination across providers of different types and specialties. An ACO that can build effective partnerships with independent physicians based on the framework identified in the research “may allow providers to expand their influence throughout the delivery system as they begin to work across locations and episodes of care to manage population health.”
