Book Excerpt: Are You Ready for an ACO Environment?
Physicians and physician groups need to assess the following:
- Current physician/hospital alignment
- IT infrastructure
- Cost at a CPT level
- Culture and philosophy
- Market (Medicare population, primary care physicians [PCP], and specialists in the area)
While conducting an assessment, an organization may choose to use surveys, focus groups, workshops, and one-on-one interviews as well as third-party objective groups who can come in to an organization and provide experience and a second opinion of the capabilities of an organization. As part of this assessment, organizations may find areas they can make improvements on right away, with or without the formation of an ACO.
As an organization begins to prepare for the ACO model to be launched by the Centers for Medicare & Medicaid Services (CMS), many executives are struggling with how to provide their administrative team, board members, and medical staff with accurate and relevant information that will help guide strategic decision-making, as well as information to evaluate the gaps as they relate to ACO development and implementation.
What is most notable here is that there is a shared recognition between hospitals and groups that they need to partner together to form ACOs and deliver accountable care. At the same time, however, a sorting out is underway that is very much geography-specific, differing from locality to locality.
The first key to a successful ACO is a strong alignment model with a hospital and other providers. If you currently have a well-established alignment with matching objectives and coordinated cultures, you may be a good candidate to participate in an ACO entity. Teamwork is essential in an ACO, and collaboration is mentioned throughout the ACO regulations. If you are not currently aligned, then perhaps you need to review that as a strategy.
Technology is another critical factor. The exchange of patient information between ACO participants is essential to meet the requirements of an ACO. Additionally, CMS has indicated that electronic connections with patients and their caregivers will be important as part of the delivery of care and customer service to the beneficiaries. Are you currently using an electronic health records (EHR) system that has been approved under Meaningful Use? If not, do you plan to implement one in 2012? Automation of data for patient records is significant and the ability to share the data within the ACO is a requirement.
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