Los Angeles hosted the Third National Accountable Care Organization Congress from October 30 to November 1. More than 1500 individuals participated in this leading forum on ACOs and related delivery system and payment reforms.
Along with Terry Spoleti, president of Glenridge Healthcare Solutions, I presented at the Congress during a session entitled How to Successfully Integrate Specialists into an Accountable Care Organization. A copy of our presentation materials is available here.
We began our presentation with a brief tutorial on accountable care economics, including the “rob Peter to pay Paul” reality, i.e., primary care physicians’ opportunity to enhance their compensation through shared savings programs by reducing costly inpatient admissions and specialists’ services. Next, we discussed how these economics are likely to impact specialists, as primary care providers become more selective in making referrals.
Terry, whose firm specializes in network development and data management for providers and payers, demonstrated how providers and consumers soon will have access to reports regarding specialists’ scores on quality and cost measures. In the very near future, these scorecards will have a significant impact on network and referral decisions, as well as specialists’ reimbursement rates.
Finally, we discussed specialists’ strategies for adapting to the new world of accountable care. Of course, all physicians need to be aware of, and focus on, improving their quality measure scores and their efficiency. For specialists who are currently part of an integrated delivery system, the focus should be on expanding the patient base served by the IDS, particularly by expanding services into new markets.
One such strategy is the development of a service line franchise. Often referred to as “outreach programs” in the past, the service line franchise enhances the relationship between providers and gives smaller communities the opportunity to participate in a continuum of care for a specific disease state or chronic condition. Local providers have access to, and training on, care protocols to manage patients closer to home, with strong referral relationships to a tertiary care provider for more specialized care.
For independent practitioners, we discussed the opportunity for “clouding,” i.e., clinically integrating with other specialists in the community (the “cloud”) while maintaining economic independence. Among other benefits, clouding provides an opportunity for branding, and identifying a specialist with a network of high-quality, cost-effective providers. When structured and executed appropriately with respect to state and federal regulatory issues, clouding also presents an opportunity for joint contract negotiations with payers.
All of the presenters at the ACO Congress offered keen insights into emerging models of care delivery. The level of energy among the attendees reinforces our belief that change is here, and now is the time for providers to make their own destiny.