Seven Questions Physicians Must Ask Before Participating in an ACO

August 28, 2013

Don't commit to ACO participation before doing your homework. Here are seven critical questions to ask.

Considering participating in an accountable care organization (ACO)? Ask these questions first:  
 
1. Do I believe in the concept? To be successful in an ACO you will need to commit full force, Mark Wagar, president of Heritage Medical Systems, an affiliate of California-based Heritage Provider Network, which is also an affiliate of the Heritage California Pioneer ACO told Physicians Practice.  "One of the challenges ACOs around the country see on occasion is you get a lot of physicians signing up and some may not realize this is not just making a list of my fee-for-service Medicare patients and in a year or two I'll get some bonus money," Wagar said. "This is a commitment to change the way that we all attack healthcare and health status in this country. It's a vehicle for change, so you have to be sure that you understand you're engaging in an organization and with colleagues that expect you to change the way that you're practicing."

2. Will I have a voice in the decision making? Don't get locked into participating in an ACO without ensuring your practice will have a voice in the decision making and structure. As with any new partnership or agreement, it's important to ensure someone is looking out for your best interests, particularly when it comes to how shared savings will be doled in (or out).

3. Am I prepared to let data take center stage? Successful ACO participation will require you to more thoroughly track and monitor your patients. "Before you even contemplate participating in an ACO, you need to know that you know your data," Cindy Dunn, a senior consultant with the Medical Group Management Association, told Physicians Practice. "You really have to know your patient population." That means you also need to be equipped with the right technology to track and monitor data. "You either have to have an EHR or be part of a registry," said Dunn, adding that while you could participate in an ACO without these technologies, it would be a lot harder to be successful and you'd be operating a lot less efficiently. 

4. Will this ACO help me down the right road? Does the ACO give you additional capabilities that your office wouldn't otherwise have? Will it provide data to help ensure you can better track and monitor your patients?  Does it have "staying power"? Those are all important questions to ask and consider, said Wagar. "Even if you have really good results after the first year there are going to be challenges, there are going to be changes in the population you have," he said. "This is a long-term process of changing many aspects of the way we provide care, the way we think about health status, and the way we engage with our patients."

5. What are the means by which this ACO will identify at-risk patients? A primary ACO objective will be increasing prevention, reducing hospital admissions and readmissions, and better managing patients with chronic conditions – all of that will lead to lower healthcare costs. As a result, it's important to have tools that will help you identify patients at risk of an acute event, Andrew Croshaw, a partner and managing director of the Center for Accountable Care Intelligence, which researches and analyzes the evolution and future of integrated care at Leavitt Partners, a Salt Lake City-based consulting firm, told Physicians Practice. Those tools could include patient communication platforms, so that patients can communicate when they are having issues, data analytics services that can take claims and clinical data and analyze that for patterns and anticipate risk, and an information exchange that allows providers to share data with one another that might influence treatment decisions at the point of care. 

6. Do I play well with others (and do I want to play with others)? ACO participation will require you to partner with other healthcare systems, such as nearby practices and hospitals. That's a big consideration for independent practices that want to retain as much of their autonomy and independence as possible.

7. Does the ACO understand the risk? "If I were being approached about participating in an ACO, I would want to understand whether the ACO understands the downside financial risk, whether they have reinsurance in place or other contractual or organization methods to limit the downside risk," said Croshaw. "As we are tracking the movement we see providers who are hungry to experiment but their understanding of the actuarial science around risk management doesn't always match up with their appetite to get into risk-based contracts."