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"Historically, we have been trained to do things
in an opposite way," Wessels says. "Physicians are
having to change quickly, and health-care organiza-
tions were originally set up based on a compensation
model that is changing before their eyes."
Participation and leadership from physicians is
vital in making ACOs work, according to Woodson.
But in many places, the deeper pockets of a local
hospital or hospital group are required to finance
the technology, sta and other upfront costs associ-
ated with launching an ACO. While hospitals may
be needed to make an ACO work, they also can
"become a cost center" when the model takes o , as
the emphasis will be on treating patients in medical
o ces and keeping them out of the hospital to cut
costs, Woodson says.
It can be challenging to undertake the prospect
of an ACO while maintaining "the mindset of rede-
fining value to everyone," Tomchaney adds. "The
goal has to be an outcome of better care at a much
Finally, ACOs just won't work well in all areas.
"Not every geographic location can be an ACO area,"
Wessels says. "You can't stack incentives in every
place. The majority of the impact of ACOs will be
in population centers."
For hospitals and physicians who are considering
a move to an ACO or similar coordinated care model,
it's helpful to have a broad understanding of the cul-
tural transformation risk. When Sg2 clients consider
launching such a collaboration, "we caution them
that going into this model is very risky," Woodson
says. "You need to understand what your financial
exposure is going to be. And be deliberate about your
timing: Don't be reactive."
To make an ACO work, advanced systems for
transferring information are required. In many orga-
nizations, a switch to electronic medical records and
the use of mobile devices such as smart phones and
tablet computers may have set the groundwork for a
successful ACO, Tomchaney says.
In addition to providing systems for various pro-
viders to communicate with each other about patient
care, successful ACOs also utilize technology to get
patients more involved in their own care.
"You have to have a transformation of the care man-
agement process that lets you reach out to patients
in ways you haven't before," Tomchaney says. "For
instance, at Franciscan Alliance we have a patient
portal that allows patients to get online to see their
lab results, make their own appointments and do
other tasks. That helps empower the patient to be
more accountable in their own care."
While not every health-care organization is rushing
to form an ACO, there is widespread agreement that
the future model of providing care will look di erent
"Many of our clients see this as a transition model,"
Woodson says. "It may not necessarily be the way
we'll end up, but it is a change that is moving us on
the way to where we're going."
What will the end result look like? Nobody can be
sure, but there is likely to be considerable variation,
Woodson says. For instance, in some rural areas, ACOs
may not be feasible. Academic medical centers may
have relationships with ACOs but not be a part of one.
Each facility and group of providers must consider
the needs and resources of their local communities.
Even if forming an ACO is not the answer for your
organization, it's important to be asking questions
and looking for the right solution.
"The current costs of health care are not sustain-
able," Tomchaney says. "The country is aging. If we
think we have issues today, think of what it will be like
10 years from now, with no more money and more
people needing health care. We are clearly at a tipping
point. This reality isn't going to go away, no matter
the outcome of the upcoming presidential election.
The need for more coordinated care is here to stay,
no matter what." S
"MANY OF OUR
CLIENTS SEE THIS
AS A TRANSITION
MODEL. IT MAY
BE THE WAY
IS MOVING US
ON THE WAY TO
Successful ACOs utilize
technology to get patients more
involved in their own care.
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