The ACO Alternatives
An article last month on Becker’s Healthcare by Steve Ronstrom provides viable alternatives to ACOs (Account Care Organizations). The article, entitled, “As Interest in ACOs Wanes, It’s Time to Do the ‘Next Right Thing’,” points out the need to return to the fundamentals of meeting the needs of patients, while effectively integrating health services. SignatureMD agrees with many of these ideas and hopes that concierge medicine can help encourage more self-sustaining physicians.
Although ACOs have courageous objectives, the “proposed regulations are too complex,” making them in effect, futile. Hospitals are especially in a critical position with ACO implementation. According to Ronstrom, there are 12 steps hospitals can take to do the next right thing without accepting ACO agreements:
1. Focus on patients. It seems the focus has shifted away from the patients and to costs. Ronstrom suggests, “We should start reexamining the patient experience and match it up with our delivery system.” He also believes, “We need to engage in more patient outreach, such as making sure medications are used, educating patients on compliance and providing support.”
2. Study community needs. It is a goal of many hospitals to study and understand its community. Ronstrom says, “We need to keep trying to gain the trust of patients and the community at large.” This is a primary way in which the community can trust its healthcare providers.
3. Partner with payors. There is a disconnect between the data hospitals have and the information payors possess. While hospitals can see payors’ databases for metrics, a payor cannot reciprocate. It is essential that they can communicate more easily to improve quality and productivity of care.
4. Get physicians engaged. As hospitals obtain more physicians, they will need assistance in achieving maximum efficiency. Ronstrom believes, “Hospitals need to train physicians on how to operate within the organization and to get decent payor contracts.” He also says they need to “streamline management of employed physicians” by organizing them into several groups, rather than individually.
5. Create physician-led systems. Often, physicians don’t feel empowered in a hospital setting. So, physicians should be involved in more prestigious levels of leadership to help create a “strategic vision.” According to Ronstrom, “This means more physicians becoming hospital CEOs or working in close partnerships with non-MD CEOs.”
6. Adopt the medical home. As we move from pay-for-procedure to pay-for-population healthcare, it is important that each patient “is given a personal physician, providing first-contact, continuous and comprehensive care.” Then, “the physician assumes responsibility for either directly providing the patient’s healthcare needs or arranging care with other qualified professionals.”
7. Help physicians find new models of care. Although hospitals and physicians are experiencing more overlap, physicians should still be empowered to think entrepreneurially. Ronstrom points out that “more physicians are getting involved in concierge medicine, which involves charging patients a direct fee and dropping out of Medicare and private insurance.”
8. Place ancillary testing and other outpatient services in the same building with physician offices. The goal is to provide convenience and an ability to more easily monitor patient wellness.
9. Improve IT. IT plays a fundamental role in the efficiency of today’s hospitals, so it’s important that healthcare institutions continue to expand and improve their systems. Ronstrom expresses that “IT has to be linked to outpatient centers and physicians’ offices and plugged into insurance information.”
10. Continue working on centers of excellence. While many anticipate that tertiary care will end up in nationwide centers, Ronstrom believes “there will always be a demand for locally grown tertiary care as long as it is of high quality and has sufficient volume.”
11. Put UR (utilization review) front and center. There is significant opportunity for hospitals to “improve relations with rehab centers, nursing homes and home health agencies for the whole curriculum of care.” Ronstrom says, “The UR director should be in the hospital’s leadership group and the UR department should be regularly reporting to the CEO.”
12. Create new delivery models. The pressure to lower costs continues to grow, meaning hospitals and all healthcare delivery models need to be creative about their approach to medicine. Ronstrom points out that a patient’s home is the least costly facility for care, so there needs to be accessible options to execute this through home-monitoring technology.
These are just some of the ways hospitals – and healthcare providers collectively – can thrive and meet the needs of patients without ACO agreements.