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HFMA Live: Accountable Care Financial Systems

June 25, 2012
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ACOs are gaining traction as a force in healthcare

This year’s annual conference of the Healthcare Financial Management Association in Las Vegas is an great example of interesting timing, because it may well coincide with the Supreme Court’s expected to announcement of its decision on the constitutionality of the Affordable Care Act.

Following a pre-conference workshop on Best Practices for Designing Accountable Care Financial Systems I asked its presenter, Daniel J. Marino, president and CEO of Health Directions, Oakbrook Terrace, Ill., what impact the Supreme Court decision, when it is announced, will have on ACO development. In his view, regardless of the decision, ACOs are a trend that is here to stay: provider organizations have already provided the momentum in that direction. ACOs make sense, he says, and there is no disagreement over the need to re-engineer care and tie it to costs.

In his presentation, Marino outlined seven steps to launching an ACO:

  1. Assess the readiness for accountable care. Evaluate the organization’s strategy versus the acceptance to change; look at the strengths, weaknesses, opportunities and threats related to positioning for accountable care; look at specific requirements for an ACO; and develop an ACO roadmap.
  2. Assemble a project team consisting of physician leaders, administration, and IT support.
  3. Create a legal and organizational framework, including physician leaders, administration, and IT support.
  4. Build clinical integration, deciding what to track, measure and evaluate; how to create managed clinical value; and chronic disease, prevention and wellness.
  5. Build the IT infrastructure, including an EHR, HIE, and interfaces; data architecture; data mapping; and population management.
  6. Engage community physicians. Educate the provider community; foster clinical collaboration and coordination of care across the care continuum; and provide positioning and incentives.
  7. Engage patients in the community. Build patient portals and education avenues; outreach programs for health risks such smoking cessation and diabetes; and provide wellness and prevention programs.

To be sure, launching an ACO is a complex undertaking with considerable upfront investment. Provider organizations have to build a strategy, manage their cost structures, and understand the cultural changes that are necessary to make ACOs possible. Strategies may vary according to an organization’s size and resources, he says, and it may be necessary to incorporate various components selectively when building an ACO.