Middletown, N.Y.-based Crystal Run Healthcare was one of the original 27 accountable care organizations (ACOs) to participate in the Medicare Shared Savings Program. One of its most significant challenges has been moving toward value-based reimbursement while the majority of its payers are still operating on a fee-for-service basis.
Scott Hines and Jonathan Nasser, Crystal Run's chief quality and chief clinical transformation officers, respectively, offered the following advice to other organizations considering the ACO pathway:
Spend time on the "why." One of the first steps in the transformation should be explaining to providers why the ACO model is the best way to deliver care, as well as the best way to ensure long-term financial security for physicians as more payers move toward alternative payment models.
Take a grassroots approach. The success of Crystal Run's "variation in care" initiative — which resulted in $4.2 million in savings in its first year — hinges on getting provider input into best practices for treating common diseases. "Having providers hold each other accountable worked much better than having a committee develop something behind closed doors," says Hines. "You cannot underestimate the importance of physician engagement."
Be patient. Becoming an ACO is not an overnight switch and requires substantial changes in terms of physician and patient behavior, says Nasser. Be prepared to test different methodologies and invest significant effort across the organization.
Engage patients. Crystal Run created an advisory council of Medicare patients to help create a brochure about how the ACO model benefits patients. "Patients will hear about things like rationing care in the media, so it's important to educate them about what an ACO really is," says Nasser.