Five years ago, the term accountable care organization became a trending buzzword. However, as we quickly learned, if you've seen one ACO, you've seen just that … one ACO.
That's because virtually all ACOs have a unique governing structure and provider participants—from physician-only, to physicians and hospital partners, or hospital and skilled-nursing facilities, just to name a few.
There really is no prescriptive definition of an ACO. The concept is evolving as the market shifts away from the traditional fee-for-service payment model in an effort to drive down the cost of care, while improving quality and health outcomes for patients.
The healthcare industry's commitment to value-based care remains strong. Even with uncertainty surrounding the Affordable Care Act, organizations continue to expand value-based arrangements, including Beth Israel Deaconess Care Organization, or BIDCO.
Our journey began in 2012, when we launched as a Medicare Pioneer ACO program, a new CMS Innovation Center initiative, and soon after formed an ACO with joint hospital/physician governance. In 2017, CMS selected BIDCO to participate in the Medicare Shared Savings Plan. And this spring, we entered Massachusetts' new Medicaid ACO program. Today, our provider network includes more than 2,600 physicians and eight hospitals, including Beth Israel Deaconess Medical Center in Boston.
Other organizations may find useful some of the lessons learned from the front lines of our evolution as an ACO.
Understand your situation. Organizations that wish to transition to an ACO model must first take inventory of their organization: Who are your stakeholders? Which local providers would add value to your ACO? Are incentives clinically and financially aligned for ACO providers? Assessing these questions will help you create the right governance structure needed for success in value-based contracts.
Knowing your patient base is also critical because there is not a one-size-fits-all program for population health management. Assess your current care-management program and only start a value-based ACO when you have care-management programs in place for each patient population (e.g., commercial, Medicare, Medicaid) your ACO will serve. Expansion can come later as you gain experience and meet risk-contract performance measures.
Communicate clearly. ACOs that are transparent about their objectives and how to achieve those objectives earn the trust of their provider partners. Open communication fosters engagement and buy-in among providers.
At BIDCO, our ACO structure allows a diverse community of physicians to participate in our organization, including a large academic practice, community health centers and independent physicians. One challenge early on was that our network's diversity had the potential to create information vacuums. We worked to establish multiple communications channels, including email newsletters, physician town halls, routine meetings with ACO clinical leaders, and direct interaction with ACO stakeholders. We also established a team of performance improvement facilitators who visit practices to review quarterly data points and provide guidance on meeting performance metrics that support ACO objectives.
As BIDCO matured, having reliable, trusted communication channels has proven a valuable advantage in disseminating key messages.
Invest in technology. Data analytics is the key to population health management and helps providers improve clinical and quality outcomes and financial performance. Analytics can show providers how they are performing on key quality measures compared with their peers. In addition, technology can aid coordination of sharing information and best practices across an ACO's provider network.
ACOs better manage cost and quality in a value-based care environment and are a desirable construct for organizations that see the benefits of sharing risk and reward. But the ones that thrive are those that recognize there is no "cookie cutter" model. Their governance and infrastructure reflect their values and drive success; they invest in technology that improves patient care; and their providers understand the objectives of population health programs and how they align with shared goals across the organization.
Successful ACOs don't happen overnight. They take thoughtful preparation, time, resources and the willingness to try.
