At the Becker's Hospital Review CEO Strategy Roundtable in Chicago on Nov. 5, Molly Gamble, editor with Becker's Hospital Review, moderated a panel on the most pressing accountable care organization issues and trends.
1. The problem of data. ACOs are conceived with a lofty goal in mind: the managed care of a large patient population. The path to achieving this goal is data-driven, but when an organization first begins it has a shallow pool of information from which to pull. "Don't be paralyzed by the lack of data. In the inception of an organization, there is no data," said Michael Kasper, CEO of DuPage Medical Group. "But, that should not lead to a lack of action. There is a lot you can do to manage a population and it begins with the 5 percent of the population that drives 50 percent of the cost."
2. Post-acute care space. The post-acute care environment and how patients receive this care plays a central role in quality and cost of care. "We have case managers in the emergency department. Every ED has one to help patients get to the right setting," said Linda Deering, president of Advocate Sherman Hospital. "We also recently launched a predictive analytics model with Cerner to help determine the best post-acute care setting. Great care at a better cost point is really our goal."
"The post-acute space is an area that cannot be overinvested in," said Miles Snowden, MD, CMO of TeamHealth.
3. Stickiness. ACOs are an evolving strategy and one of the largest concerns – stickiness – deals with keeping patients under the organization's umbrella of care. "We've struggled with stickiness in the Medicare Shared Savings Program [ACO]," said Ms. Deering. "There is no incentive to keep them in the office. It comes down to the basic relationship with the physician and office staff."
4. Physician extenders. Population health is an immense responsibility, one that cannot be borne by physicians alone. As ACOs move forward with population health, the concept of physician extenders has come to the fore. "The system is still trying to figure out how extenders work best and where," said Mr. Kasper. "On the chronic side, we want a physician in the middle, but three or four extenders can work around that physician. If you become overstaffed from a physician standpoint, it becomes too expensive."
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