Systemic changes vital to ACO success

Accountable care organizations (ACOs) might be today’s hope for grappling with healthcare costs and bumping up quality; however, according to one expert, they are doomed to fail without one key element.

Without systemic changes -- the desire to change the way healthcare is delivered -- an ACO is most likely doomed to failure, said Jim Hansen, vice president of the Accountable Delivery System Institute for Lumeris, a St. Louis, Mo.-based company that offers technology and service solutions for accountable care models.

“If all you’re doing is signing a contract, you really aren’t going to garner the kinds of benefits that everyone’s expecting at that level,” Hansen said of today’s ACO model.

Doctors need to alter their behavior and increase patient engagement, Hansen added.

Hansen gives the name “ACO 2.0” to organizations that are able to grasp this concept of systemic change. ACO 2.0 organizations, like the kind Lumeris deals with, are five or six years into the ACO model, and are consistently beating national quality averages.

“They are bending the cost curve and seeing results, Hansen explained. “Every year they are able to find additional opportunities to save money.”

In terms of the fairly new federal ACO programs – the Pioneer ACO project and the Medicare Shared Savings Program – the jury is still out, Hansen said. “They are only just now starting to turn their attention to how to manage populations. From a maturity standpoint, they have only been operating for about six months. It will take a number of years to see the true benefits.

As Hansen sees it, most people equate the ACO models with federal programs begun under the Affordable Care Act, but there are lots of ACO-type models that were established years ago in the private sector.

In addition to physician buy-in, the key element to making ACOs work is information technology, “You’ve got to have technology-enabled tools,” Hansen said. “Trying to manage populations on spreadsheets won’t work.”

Hansen’s advice to organizations starting out with an ACO, is select something to “attack” first -- readmissions, for example. “Pick a pain point for you that is easily addressable, then go at it deep,” he advised. “It takes time, but you have to be committed."

Most doctors with whom Hansen works as an ACO consultant say they love ACOs. “It’s a professional renaissance for them," he noted. "They tell me that this is the way they’ve always imagined practicing medicine would be like. They’re thriving, and that’s what gets us all excited.”

[See also: Will ACOs fail?]