Lessons learned from organizations that integrate specialty care into ACOs

Specialty care will be important to the financial success of accountable care organizations, but ACOs still have a lot to learn in order to reduce costs for specialty care, according to post on the Health Affairs Blog.

Specialists participating in ACOs will need to be held accountable for population health and the overall care of patients, but most ACOs haven't yet determined how to work with specialists to develop new care models and change practice patterns that will reduce costs, write Leslie Korenda and Sarah Thomas, who both work for the Deloitte Center for Health Solutions. 

After interviewing leaders at various types of ACOs, the authors said they learned the process of integrating specialty care will involve:

  • Influencing primary care referrals and care management by encouraging primary care providers to refer patients to specialists when truly necessary and to specialists who aim to keep costs low
  • Working with primary care physicians to redesign the care process so it meets the goals of the Triple Aim
  • Starting with a small pilot project before expanding to other areas
  • Leveraging data by sharing the high-level information with physicians
  • Linking specialty care performance to risk, payment and incentives

However, among the challenges that ACOs face are that few have experience sharing risk with specialists and most specialists still operate on a fee-for-service model and don't know how other models would work for them, according to the article.

"It can be hard to get started on efforts to integrate specialty care, because neither the 'top' nor the 'bottom' is in a strong position to (or motivated to) press for change," the authors write.

Healthcare policymakers argued recently that value-based care payment models also need to focus on compensation for providers. Changing financial rewards for providers is one way to stimulate innovation in delivering person-centered care, they said.

Meanwhile, research shows that specialty practices owned by a hospital are significantly more likely to belong to an ACO or a medical home. More than a third--36 percent--of hospital-owned single-specialty practices participated in an ACO, FiercePracticeManagement previously reported.

To learn more:
- see the Health Affairs post