What Do Accountable Care Organizations And New Cars Have In Common?

If you were in the market for a new car would you simply walk on the lot and sign the papers?  Doubtful.  You would likely take your choice for a test drive, maybe read some reviews, and see if the features match your needs.  What has this got to do with ACOs?

Recently I got a call from a health system that said they had already done a readiness assessment and a feasibility study and were ready to form an ACO.  Since we really don't know what an ACO will look like until federal regulations are released and comments are returned I'm uncertain how these folks could have done a feasibility study.  Using the large managed care networks in California as a model may be a big mistake.  They are ready to buy their car with little or no understanding of what the car is supposed to do for them or how it runs.

The message in this is "don't rush to market until you know what the market requires".  We suggest that you learn to walk first and this might include select DRGs or procedures that might be trails for hospitals and physicians to streamline and coordinate care.  see how that goes before you take on 5,000 new patients.

A client earlier this year was thrilled that they negotiated a global capitation contract with their local BCBS plan.  They were convinced that their 5 hospitals and 500 physicians were on their way to the bank.  They, unfortunately, ignored the fact that their data system environment was uncoordinated, that their physicians did not exhibit the most cost effective care patterns, and that they really had no firm idea of what care actually cost.  The shocking outcome was that the deal was a formula for financial losses.  Surprise!

If you have done a readiness assessment have someone check your work.  Have you really come to terms with this hospital/physician integration thing?  Do you really know where you stand relative to best clinical practices? 

Our opinion is that the ACO delivery model is coming but it is still too early to take on risk in an environment of uncertainty. This certainly does not mean "do nothing".  Begin the assessment and learning process so that you'll be ready to act when the picture becomes more clear.