Nudging Physicians Toward Accountability

To succeed, accountable care–type organizations should consider focus on culture as well as clinical and economic integration.

Cultural integration, Knight said, is not only the most important aspect, but also the most difficult to achieve.

Knight harkens back to that e-mail—it was exciting, he said, because it shows that even physicians who are practicing independent of each other have a common vision. Common motivation helps form the bedrock of a common mission and vision for an ACO and is the foundation for establishing trust and breaking down barriers between key players.

“The piece that is really essential to accountable care is to bring physicians and healthcare systems together in a way that they’ve never been before,” Knight said. “To really bring physicians into your business model requires a lot more than a contract and a paycheck.”

And integration needs to be more than clinical: Physicians must also be an integral part of the business model, he said. And that means more than compensation and employment, he added, but bringing together physicians who don’t all work for the same organization.  

“Systems and physicians that don’t have employer-employee relationships [can] come together and economically integrate in ways that previously would have been frowned on, that would have raised issues with regard to antitrust.”

In addition to advice about what organizations should do to succeed, Knight offered the audience a list of four traps to avoid.