Many see Accountable Care Organizations (ACOs) as a potential solution to the expensive and inefficient U.S. healthcare system. There are approximately 500 to 600 ACOs in the U.S. providing care to 15 to 17 percent of the population. So far, these ACOs have yielded measurable quality improvements and saved the healthcare system an estimated $380 million. However, ACOs represent a drastic change in the way healthcare is paid for and delivered in this country, meaning the healthcare organizations that participate in these programs will have to change the way they staff their facilities.
A new way of paying for healthcare
ACOs represent a shift in thinking about how healthcare providers treat the population. As the name suggests, the current fee-for-service payment model pays healthcare providers for each procedure they perform. Essentially, the more services and procedures an organization bills, the more money they receive from insurance companies, Medicaid, and Medicare. Therefore, healthcare organizations are incentivized to treat the sickest patients with the most expensive procedures, as often as possible. The ACO model, on the other hand, incentivizes healthcare providers to manage each patient’s health and provide preventive care so patients will not need expensive procedures and hospital stays. Rather than paying healthcare providers for each procedure they perform, the ACO model rewards healthcare providers who keep costs down by giving them a share of the savings. If healthcare providers and healthcare organizations do a poor job of managing a patient’s health, and he or she requires expensive treatment, they incur some of the risk associated with the higher cost.
More team-based providers
For years, primary care physicians and specialists worked in silos, rarely collaborating with one another. Providers treated the conditions and complications that patients presented with, and when they had fixed the problem, the patients were discharged. Although providers were encouraged to share information with one another, several factors such as incompatible patient records systems and improper documentation made coordinated patient care a challenge. The ACO’s pay-for-performance model addresses this issue. Primary care physicians, specialists, and non-physician practitioners work together in multidisciplinary teams to provide holistic care to a population of patients. Since all these providers are part of a defined team, sharing information is much easier, allowing the team to treat the whole patient, not just the problem he or she presents with. This team-based approach is also changing the way healthcare organizations evaluate potential employees. Particularly, healthcare organizations are now placing greater importance on skills that will enable a provider to thrive in a team setting, such as collaborative and adaptive skills. Anne Folger, senior director of physician recruitment for Banner Medical group told Becker’s Hospital Review, “We look for someone who is very collaborative and has a high tolerance to changing environments, because we know we have to evolve.”
More primary care providers
Because ACOs place a high value on managing holistic patient health, primary care physicians play a crucial role, leading the multidisciplinary teams, diagnosing the patients, and creating a care plan that the other members execute. The importance of the primary care provider in an ACO has caused healthcare organizations to recruit and hire primary care physicians at an accelerated rate. According to the American Medical Association, 60 percent of family practice physicians are employees or independent contractors However, physicians are not the only primary care providers sought after by healthcare organizations. A recent survey showed that 83 percent of healthcare executives expect to increase the recruitment of NPs and PAs to provide care in an ACO. PAs and NPs are integral to the multidisciplinary team, typically focusing on preventive visits and freeing physicians to focus on more complex patients. The physician shortage is placing an even greater value on PAs and NPs, who are able to take on some of the diagnosing and care planning responsibilities in organizations where the physicians are stretched thin.
As the ACO model evolves, healthcare organizations will continue to tweak their staff to meet the requirements of the program and their patients. Earlier this month, CMS published a proposed rule that would give ACOs more time to develop the infrastructure needed to succeed in the ACO model. Under the proposed rule, ACOs that fail to slow spending in their first two years would no longer face penalties after the third year, but all ACOs must assume the risk of penalties after six years if they want to remain in the program.