10 do's and don'ts of accountable care organizations

The uncharted waters of accountable care organizations (ACO) don't make for smooth sailing. Experts from Massachusetts General Hospital and the University of California detailed 10 potential mistakes that ACOs encounter when working with the Centers for Medicare & Medicaid Services or private payers, in a commentary published this month in the Journal of the American Medical Association.

The pitfalls include overestimating the organization's capabilities and not engaging key stakeholders. Among the authors' tips are the following:

1. Don't overestimate ability to manage risk: Citing the failed managed care experiment of the 1990s, the authors wrote that many organizations inappropriately gauge their ability to manage and measure inpatient care. Keep in mind that the goal of the ACO is to manage care across the continuum, which may require merging hospital and physician resources, at an estimated cost investment of $1 million to $12 million, according to the article.

2. Don't overestimate ability to use EHRs: Similarly, electronic health records can be more challenging than most organizations realize. Remember to create compatible hospital and physician information systems for true integration.

3. Don't overestimate ability to report performance measures: Gain the necessary technical support to collect, analyze and report performance data to assess how the ACO is delivering care.

4. Don't overestimate ability to implement standardized care: One of the main goals with ACOs is to reduce variations in care by standardizing protocols. Involve clinicians in implementing and documenting protocol outcomes, which will take time.

5. Do balance interests of stakeholders: Remember to preserve the hospital-physician relationship by offering primary care physicians and specialists a role in governance and management processes.

6. Do engage patients in care: Provide patients and their family members with the tools they need to manage their own care, particularly with chronic conditions.

7. Do contract with cost-effective specialists: Because primary care physicians and patients are not limited to a single ACO, they are free to choose. To make the ACO attractive, consider contracting with cost-effective specialists.

8. Do navigate regulatory and legal environment: Protect the ACO from any possible violations of antitrust laws, Stark, and antikickback legislation.

9. Do integrate beyond the structural level. Engage health professionals across the continuum to align interests and rewards.

10. Do recognize interdependency. Under- or overestimating any of these pitfalls can snowball into other problems. Recognize that stakeholder engagement and organizational assessment play off each other to help improve care and reduce costs.

For more:
- check out the JAMA commentary

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