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 of payer and hospital executives who discussed their points of view on accountable care organization progress.
Payer perspective
ACOs require both payer and provider buy-in to succeed. "[Payers] define an ACO as an arrangement in which we can hold providers accountable for cost, quality and service outcomes in a defined population with a PPO benefit structure," said Scott Saran, MD, MM, CMO, Government Programs, Health Care Service Organization. "We are all interested in driving the health system away from fee-for-service and volume-based arrangements."
While hospitals and physicians alike are entering the ACO space, payers are often attracted to physician-led organizations. "It is rare for us to find a hospital that understand the focus on total cost of care," said Dr. Saran. "We are seeing some really savvy physician leaders. They recognize they need to take on risk in order to remain independent. We are aggressively pursuing physician-led ACOs."
Hospital leader perspective
Though it may be difficult, hospitals are eager for a seat at the ACO table. "Try as we might, we have yet to find a shared vision with provider, payer and employer," said Scott D. Nygaard, MD, MBA, CMO, Physician Services and Network Development, Lee Memorial Hospital System.
"We need to see innovation," said David DiLoreto, MD, president and CEO, Presence Health Partners. "There are encouraging signs in bundled payments. We can create a while system simply by aligned incentives."
Moving forward
Looking to the future, hospitals will have to address a number of challenges to perfect and sustain the ACO model. "The major challenges are payer relations, leadership engagement, physician alignment and patient engagement," said Paul Stewart, president and CEO of Sky Lakes Medical Center.