Reform Update: New reform-related jobs require unprecedented skills

Brown & Toland Physicians, a San Francisco-based network of 1,500 independent doctors, is looking for a “PPO ACO program manager.” Their search to find an experienced candidate may be difficult, however, because—as is the case with many healthcare reform-related jobs—the position didn't exist two years ago.

The person hired for this position will be responsible for planning, contract negotiation, implementation and ongoing operations of Brown & Toland's preferred provider organization-related accountable care organization programs.

“I wrote the job description from scratch a year and half ago,” said Stephanie Mamane, Brown & Toland PPO and ACO director, adding that the new hire will only be the second person to ever fill that position. “We need someone who can be a facilitator to health plans and our internal teams,” she said.

While some organizations create new leadership roles as they aggressively pursue new payment and delivery models fostered by the Patient Protection and Affordable Care Act, many others instead appear to be foisting new responsibilities on existing managers and executives. Either way, they are adapting their leadership roles in response to a fundamental shift in how they will get paid.

In addition to the Medicare Pioneer ACO program, Brown & Toland is involved in five ACOS that are responsible for 85,000 patients, Mamane said.

“If you've seen one ACO, you've seen one ACO,” she said, adding that the rules are different for each, and there are no standardized quality or performance metrics. “It's pretty fluid. Some programs are very well defined and some are not so well defined,” she said.

ACOs typically have started showing results about 18 months into the program, but Mamane said it's vital to have a clear picture of an ACO's performance much earlier than that.

“It's important to have a program manager monitor performance throughout the year so we won't have major surprises,” Mamane said, adding that monitoring allows the program to be nimble enough to change course if performance is not meeting expectations.

Mamane said her company is looking for someone with program- or project-management experience. Healthcare experience is a plus, but it's not required.

“We're finding some folks, but it's not a huge pool to draw from,” she said. “There are not many candidates with direct ACO experience.”

For candidates seeking career advancement, Mamane said the job has a “growth path” because it offers on-the-job exposure to internal health system departments, health plans and government agencies.

Mamane predicted healthcare reform will create more new positions, but that even more jobs will be created through insurance exchanges, which—for now, at least—cover more patients than ACOs.

Dr. Susan Turney, president and CEO of MGMA-ACMPE, said she has observed healthcare reform change existing roles more often than it has inspired new titles and positions.

“What we see more is that jobs are evolving and descriptions around those jobs are evolving,” Turney said. She added, though, that physician practices may be better off hiring a new person to tackle these evolving responsibilities, rather than assigning them to someone who probably already has a full plate.

Large groups like Brown & Toland can act as innovation factories, providing practice or business models that other organizations can emulate, said Don Crane, president and CEO of the California Association of Physician Groups, an organization with 150 multispecialty group members.

Crane added that, while the Affordable Care Act is a catalyst for the changes in healthcare leadership ranks, the main driver is the broader move toward making provider organizations financially responsible for population health.

“There is a real shift in healthcare and it will create a need for new competencies,” he said. “It isn't just the Affordable Care Act, and it isn't just moving the chairs around. The health of the population is how you will get paid.”

Elective surgeries increased more rapidly in Massachusetts than in nearby states after Massachusetts' 2006 health insurance expansion, a new study says. Discretionary surgery increased 9.7% annually, on average, after the law, according to an analysis of operations from 2003 to 2010 conducted by University of Michigan researchers and published in JAMA Surgery. Two nearby states without a similar state health insurance policy (New Jersey and New York) saw elective surgeries increase an average of 0.5% a year. So what could that mean after the national expansion of insurance, which began in January under the Patient Protection and Affordable Care Act? “Based on findings in Massachusetts, we estimated that full implementation of national insurance expansion would yield an additional 465,934 discretionary surgical procedures by 2017,” the authors wrote. Notably, the annual average rate of nondiscretionary surgery declined in Massachusetts 2.6% compared with an increase in New Jersey and New York of 1.8%.

— Melanie Evans

Follow Andis Robeznieks on Twitter: @MHARobeznieks

Follow Melanie Evans on Twitter: @MHmevans