There are many reasons ACO executives are confronted with indifference and/or a lack of collaboration from physicians.
Many physicians say they can provide cost-effective, quality care without the need for the ACO; other clinicians do not take the time to fully understand expectations, or are unwilling to participate according to protocols. And, the high turnover of physicians is often related to the small number of ACO patients some physicians see and therefore he/she is not willing to alter current clinical functions and office operations.
To overcome these and similar obstacles, we look to the underlying causes. Below are six common issues that we see on a regular basis:
1. Complex Written and Oral Communication – Communication needs to be clear, succinct and necessary. If your staff have worked on materials and talking points internally for months, the knowledge and language they use is very familiar to them. However, your physician targets are likely first learning about your ACO's details during a meeting of community physicians, through correspondence or a visit from your ACO representative. In that first encounter, make sure the physician is not overloaded with information. Provide high-level broad stroke advantages; and if not done already, send a representative to the physician's office to better understand needs and interests, and to acknowledge the vital role of the physician in an ACO.
2. Underestimated Time and Effort – Moving a physician or practice to action does not happen in a couple of face-to-face meetings with an ACO representative. Especially if the representative is not skilled in a "dialogue" form of communication. individuals in this role and many similar roles that "educate" another about a new program, event, method, etc. instinctively go into a "tell-orientation" mode of interacting. If the ACO administrator wants to create interest and alignment with physicians, the ACO contact must demonstrate interactive communication and behavior starting with the first meeting.
3. The Physician Perspective on Healthcare Gets Overlooked – A common goal in healthcare – for clinicians and administrative staff alike - is providing cost-effective quality care. However, beyond this high-level goal, needs, expectations, motivations, understandings diverge. Physicians and administrative / non-clinical staff have different perspectives on patient care, accountability, the priorities and responsibilities of physicians, the structure of the healthcare system and a vast number of other areas. Your ACO contact must understand these differences to gain the trust and credibility necessary for physicians to be willing to engage in a candid discussion. Note: Studies show that close to 50% of ACO participating physicians do not fully understand the workings of the ACO.
4. Missing the Details - Although they share common views and experiences, obviously, all physicians are not alike. To be effective, ACO contact staff want to gain insights about each physician's specific situation, knowledge and attitude toward ACOs, motivations, needs, and interests. Understanding the physician and the practice will assist your staff in directing information and comments to what is important to each physician. Knowing what questions to ask, and how to ask them in a way that is not intrusive, and how to consciously listen with full attention are all skills that can be learned. This point is typically the Achilles' Heel for an organization wanting to form relationships with physicians.
5. System of Network Development and Maintenance – It is best to systematize the function of building the network, and keeping physicians interested and then involved. There are several effective processes that allow contact / outreach staff to conduct recruitment with step-by-step efficiency and achieve ACO established objectives. To maintain physician involvement, the contact must not only educate the physician about your ACO, they should probe to assure understanding, provide ongoing updates and where relevant, provide outcome information on performance. Reviewing these reports and pointing out advantages to the physician is best accomplished in face-to-face meetings.
6. ACOs Higher Priorities – Health Affairs recently published an abstracti reporting on the views of Medicare ACO physicians participating in Pioneer, Advanced Practice (AP), or Medicare Shared Savings Program (MSSP). In this study physicians favored the delivery of cost-effective care and were positive about clinical guidelines and other tools provided by the ACO. However, most are not convinced that the ACO model is the best method for achieving cost-effective, higher quality care.
Another research report by HIRCii found in interviews with ACO leaders that among the ACO executives' Top Priority Quality Metrics, "Provider Satisfaction" ranked sixth in terms of level of importance to the executives. This ranking is understandable when you consider the metrics that rated higher: Total Cost of Care, Reduced Hospital Readmissions, Patient Satisfaction, Disease-specific Outcome Metrics, and Reduced ER Utilization.
The point in referencing the above articles is not to imply an executive should re-arranging priorities. The purpose is to suggest that in light of physician attitudes toward ACOs and the role physicians play in achieving the top five metrics mentioned, that you consider if your physician contact and recruitment staff have the skills needed to bring physicians on-board, gain their trust and interest, and influence their perceptions of your ACO and its value to them and their patients.
i Claudia L. Schur and Janet P. Sutton, "Physicians in Medicare ACOs Offer Mixed Views of Model For Health Care Cost And Quality". Health Affairs: http://content.healthaffairs.org/content/36/4/649.abstract
ii HEALTH INDUSTRIES RESEARCH COMPANIES (HIRC) "ACOs: Market Landscape, Strategic Imperatives, and Access Implications" http://www.hirc.com/acos-market-landscape-strategic-imperatives-and-access-implications
Kathleen Harkins is a healthcare consultant with extensive experience in consultative communication, business development / sales, and negotiation. Ms. Harkins designs and facilitates training programs, offers public seminars and provides one-on-one coaching for ACO and health system staff charged with physician recruitment, collaborative partnering, and organization growth. Ms. Harkins' career of 25-plus years in healthcare has consistently included working with physicians in developing business relationships, joint venture arrangements, recruitment, network management, and practice contract management.
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