There were 121 new accountable care organizations formed last year as part of the Medicare Shared Savings Program, but only 22 percent were able to cut spending and share in the savings, according to a HealthPayer Intelligence report.
One of the reasons many programs are unsuccessful could be physician buy-in; physicians are key leaders in patient care and should participate in the ACO's success.
Here are five key observations from Gregory Scrine, managing principal at Lumeris:
1. Physicians are critical to the ACO's set-up. The model and design should be physician-driven to engage the right results.
2. The majority of the board of a clinically-integrated network pursing ACOs should be physicians. Physician governance will lead other physicians to identify issues and participate in the ACO's success.
3. ACOs often focus on the triple aim — clinical quality, patient satisfaction and cost — but the most successful programs add physician satisfaction as well. Lumeris coined "Triple Aim Plus One" to include physician satisfaction and recognizing the integral role physicians play.
4. When physicians have aligned incentives, primary care physicians will drive referrals to specialists who collaborate with their care management efforts; these specialists will be responsive, efficient and cost-effective. This model works well in large markets where there is competition; in smaller markets where a single group dominates a specialty it can be more challenging to engage specialists and behavior change, according to the report.
5. The move toward value-based care is different than in the 1990s with HMOs because providers now have the technology to measure quality and the impact on quality outcomes. Healthcare professionals can also target standard care practices to maximize value for many patients.