Top 10 Clinical Integration, ACO Physician Questions

Eric Nielsen, MD, and James Smith, MBA, FACHE, The Camden Group, for HealthLeaders Media, June 9, 2011

Anyone attempting to lead physicians into a new venture such as a clinical integration program or an accountable care organization should recognize that physicians are trained to look for problems and to question everything. Physicians are perceptive and will know if the answers to their questions are substantiated by facts and evidence or if they are merely opinions and beliefs. 

Physicians are naturally and appropriately skeptical of the new arrangements under CI/ACO that will impact not only how they get compensated, but also how they care for their patients. Here are 10 of the most frequently asked questions physicians have about CI and ACOs.

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1. Is this really going to happen? Yes, the term "ACO" is new since 2007, but the concept on which it is based is not. Some physician organizations have been functioning as ACOs for many years. CI as an organizational goal has been pursued for decades, and guidance has been available from regulators since 1996 on how to use CI as a contracting model for independent physicians. There is no question that the country needs to improve its coordination, quality, and efficiency of care. CMS intends for ACOs to work or will change/replace the ACO framework with another plan for improved coordination. CI/ACOs will emerge, or providers will find that they will become a commodity with ever increasing expectations by consumers and ever-diminishing price paid per unit of service.

2. Isn't this just like the HMOs of 15 years ago? No. On the economic side, ACOs will contract with payers for current rates rather than discounts as in the HMO era, and providers will be financially incentivized to provide appropriate care with bonuses based on quality rather than return of withhold. HMOs emphasized prevention and lower utilization, while ACOs will strive for improved management of chronic conditions and appropriate utilization. HMOs assigned enrollees to primary care providers ("PCPs") as "gatekeepers." ACOs will attribute beneficiaries to a PCP, and consequently the ACO with which that PCP is affiliated, depending on the "plurality" of PCP charges. Times are also different; HMOs developed in an era of a robust economy but limited informatics whereas ACOs are evolving in an environment of robust informatics and an unstable economy.


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