The Many Roadblocks of Creating an ACO

Brevard Physicians Network

For the leaders at Brevard Physicians Network, a Melbourne, Fl..-based independent practice association (IPA) with more than 300 physicians, physician buy-in presented a similar challenge. Brenda Radke, CEO of Brevard, says she had to let physicians within the organization arrive at their own conclusion because it would give her a much higher rate of compliance, she says.  It didn’t happen overnight.

Brenda Radke

“It took me three years to get them to see that ‘she’s not bluffing, we are evolving, healthcare is changing,’” Radke says.

Brevard implemented a population health, analytics platform from Medecision (Wayne, Pa.) which allows it to integrate claims data sources. Like BHN, Brevard has required its physicians to adopt an EMR, and it is in the process of connecting that clinical data with the payer data. The idea is to give a quick, snapshot of how the physician is performing in quality measures, while providing a comprehensive, real-time record of the patient.

According to Radke, part of the challenge is convincing it the office staff to buy-in. “They’re the ones who are driving the bus,” she says, adding that the organization is trying to find ways to incentivize and inspire the staff, since they’re reaching out to patients and managing their cases.  “That’s always going to be a challenge.”

Another challenge, Radke says, is centered on creating an understanding with nearby hospitals and health networks. She says Brevard has been reaching out to these organizations and trying to form partnerships.

The Square Root of N

“Go for the low hanging fruit,” is what Nguyen would tell others who are dealing with these cultural issues. What this means, she says, is go for the people who are ready, willing, and capable of making those changes and buying into value-based healthcare. She says if you can get a group of champions on board, it will create a snowball effect.

“To make meaningful change, the formula that I’ve learned is the square root of N,” explains Nguyen. “So if you have a group of 100 that you want to change, the square root of that 100 is 10. You need to change 10 people, then they become your champions and disseminate. They can demonstrate the outcomes, then once that’s done, you can invite others in.”