If physicians don’t understand MACRA – or think they don’t need to understand MACRA – how will ACOs get physician practices to align with the requirements of the Patient-Centered Medical Home (PCMH) model?
The transition from traditional fee-for-service to value-based payment models, and the focus on patient-centered medical care and population health, has driven the proliferation of Accountable Care Organizations (ACOs).
For those who have been in healthcare for the past two decades, ACOs may be reminiscent of the integrated delivery networks of the 1990s. These networks took on heavy financial losses, as hospitals purchased physician practices and were unable to manage risks, did not put the patient at the center of healthcare, failed to align incentives in a way that would result in improved healthcare, and failed to engage physicians and integrate the culture.
“To be successful, the foundation of the ACO must be clinical integration,” says URAC President and CEO Kylanne Green. “The clinically integrated network has the very structure, skills, and attributes that were missing in the earlier failed delivery systems.”
Clinically integrated networks (CINs) are designed to support improved performance and coordinated care, and to facilitate more collaboration between providers and hospitals, being both clinically integrated and financially stable. To achieve the Triple Aim, CINs must have:
- Physician-led leadership. To achieve clinical outcome goals and ensure local responsiveness, clinical practitioners must lead the governing body.
- Alignment. There must be philosophical cohesion among providers collaborating for both clinical and financial integration. All participating in the network must agree on clinical parameters, such as patient-centeredness.
- Clinical management and coordination. This is where ultimate success lies. To deliver superior, high-quality, coordinated care services to the designated population, physicians and other clinicians must be at the forefront of setting clinical priorities.
- Integrated infrastructure. Information systems support the clinically integrated practice and enable the healthcare team to exchange clinical information, produce comparative reports, and identify at-risk members of the population.
Physician leadership and engagement is critical in each of the four pillars of success, and is key to buy-in and fostering a culture of performance excellence.
Yet many ACOs are struggling to align physician practices for transformation to the Patient-Centered Medical Home (PCMH) model. Demonstration projects have shown that practice transformation takes time, a multi-year commitment to change, physician willingness to function as part of a care team, and a culture of learning.
“Organizations need to build a framework for sustainable transformation,” says Green. “To be sustainable, it has to be physician-led, patient-centered, and have a culture that fosters continuous improvement.”
Going through URAC’s accreditation process is a path for sustainable transformation because it helps organizations ensure the systems, governance, culture, teams, and metrics are in place for success. Without this framework, a network would fail to achieve quality goals and could possibly violate antitrust laws.