ACOs – How to succeed
posted by admin at 5:52 amACOs are hot. There is no doubt. What counts for an ACO is, as yet, not entirely clear. Nonetheless, it has become a significant and important discussion.
Setting aside the need for certification of “meaningful use” of an information system by a CCHIT, there are two approaches to achieving ACO status: (1) create the entire structure, essentially at once; (2) start with what we know will be required of CMS (regardless of ACO status) that can create a platform to build toward a full-blown ACO (Think: readmissions).
For large-scale organizations, with lots of patients, money and, well, employed docs, the “whole hog” approach makes sense.
On the other hand, our group has been talking to tech companies that have great tech solutions that lack but one thing: a robust capacity to get workflows to conform to the new, higher quality, less expensive ways of caring for patients. This jibes with surveys/interviews of ACO pilot participants, which consistently said, on every dimension, that “culture” was the absolutely critical element for success in higher quality and gainsharing. From our simplistic point of view, culture really amounts to the way we work. You might call it workflow; you might call it something else. But it really just means how people coordinate their work.
Furthermore, I’d like to suggest that the platform approach will happen faster and is likely to be more successful. We’ve been working with tech companies that have partial solutions to pieces of the ACO puzzle, lacking only the capacity for building durable work practices to support and sustain improved cost and quality.
In my research–in the VERY old days–at the Harvard Business School, the “toe-hold” approach (Think: Intel, Southwest Airlines, Apple, and even Kaiser) to developing large-scale transformation is successful about five-times as frequently as the “whole hog” approach. And because healthcare is vastly more complex, this strategy makes more sense, as it allows an evolving response to an unpredictable future.
