Three healthcare executives shared the success factors that can propel shared savings and accountable care organizations and the pitfalls that can sink them, even as these value-based models are still in their infancy.
Because these models are so new, it's difficult to predict the future if they will develop along the lines that are evident today or morph into something else. But speakers at a recent webinar sponsored by Covisint Healthcare agreed that some type of risk-based arrangement will survive.
Another challenge is whether to build the infrastructure first or pursue provider contracts first for accountable care and shared savings programs. There is no set recipe yet for these new payment and care delivery models.
Craig Behm, executive director of MedChi Network Services, a subsidiary of the Maryland State Medical Society that offers management services to physicians; Joseph Pollman, executive director of knowledge management at Community Health Network; and John Haughton, MD, Covisint chief medical information officer, offered what they believe are key factors that dramatically influence success or failure.
"Infrastructure is critical as to why some ACOs are successful and others are not," Pollman said. Many of the other factors are not technical but found within the participating physicians and the culture of their organizations.
The executives said that ACOs may fail because they:
- Are doing too much too soon, which may show up in "plumbing" problems--the IT systems and data exchange
- Are doing too little--not watching their transitions of care
- Do not have enough physician and staff buy-in
- Have not yet developed aligned incentives, which require different cultural values, such as team-based care instead of physicians performing in silos.
ACOs may succeed because they:
- Immediately pay back shared savings
- Require standardization of processes and data, and transparency so measures, incentives and penalties are clear
- Have strong physician engagement
- Offer a better understanding of the program, risk of the patient at the population level and where variances exist.