5 Secrets to ACO Success

3. Physician Buy-in
"I personally don't think you can change physician behavior without developing downside risk for the ACO organization but not at the individual physician level," said Bob Margolis, M.D., managing partner and CEO for Healthcare Partners, a Torrance, Calif.-based medical group. He explained that he is a strong believer that "we can't incentivize individual physicians with downside risk."

Margolis thinks ACOs needs to have in place the structure and financial oversight to really manage downside risk before trying to implement too much on the individual level. "I don't think you're going to see the physicians shift from fee for service, volume-based medicine to care coordination without the entire ACO being held responsible."

4. High Member Volume
Proposed government regulations call for ACOs to have 5,000 members. Margolis doesn't think that 5,000 members is a sufficient base for an ACO to achieve team-based care that it is coordinated among multiple providers. He believes that to be successful, an ACO needs a strong primary care base, so double or triple that number is necessary before systems of care can be cost-effectively developed and infrastructure costs can be easily shared.