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“Flight Patterns” for Physicians Leading ACOs: Dr. Mostashari Shares Critical Success Factors

April 5, 2014
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Early lessons learned by leaders of physician-led ACOs have huge implications for healthcare IT leaders

On March 18, the American Journal of Managed Care published an online commentary from Farzad Mostashari, M.D., and James A. Colbert, M.D., under the heading, “Four Key Technologies for Physician-Led Accountable Care Organizations.” As everyone in the healthcare IT world knows, until late last autumn, Dr. Mostashari was National Coordinator for Health IT. And Dr. Colbert is a hospitalist at Newton-Wellesley Hospital, instructor of medicine at Harvard Medical School, and a consultant for the Brookings Institution ACO Learning Network. Dr. Mostashari is now a fellow at Brookings Institution.

In their article, Drs. Mostashari and Colbert identify four key areas in which they say that physician leaders of physician-governed accountable care organizations (ACOs) must excel in order for their organizations to succeed: risk stratification, advanced network management, event surveillance, and patient outreach and engagement. What they say in the article is worth pondering and commenting on, and holds numerous implications for healthcare IT leaders.

“At the Brookings ACO Learning Network,” Drs. Mostashari and Colbert write, “17 physician- led ACOs are working together in small teams to implement one or more of these new competencies, and through an open dialogue, they are sharing their experiences with other workgroup members such that all can benefit from these ‘experiments’ in health delivery. We intend to present the preliminary results of these ‘Innovation Exchanges’ at the National ACO Summit” to be held this summer, they note, “and hope to publish the key lessons learned from this project in the form of a ‘road map for physician-led ACOs’ later this fall.”

In terms of the first of the four areas, risk stratification, the authors write, “Providers who take accountability for the total cost and quality of care will use data and analytics to move beyond the current paradigm of the ‘risk score’ and toward an incremental progression to understand the different pathways by which our patients fail—and by which we fail them—be they end-of-life agonies, social isolation or family dysfunction, substance abuse, or mental health co-morbidities. Such information,” they predict, “will not be obtained simply by combing through claims data or the EHR [electronic health record], but instead through more creative approaches such as asking physicians and even patients themselves what barriers and challenges are preventing them from achieving their health goals.” It is only when providers gain that more comprehensive understanding of their patients that they will transform the current, first-generation type of risk stratification into a more advanced version that will help successfully power ACOs.

When it comes to network management, the authors have this to say:  “While many efforts at quality improvement and practice transformation focus on improving work flows within the practice, ACOs must also be able to create ‘flight plans’ for their patients that ensure they receive high-value care across the care continuum.” Importantly, they note, that means not only crafting provider networks, but also putting into place the kinds of “shared care plans, timely electronic communication, and coordinating more closely with the primary care provider” that will truly serve plan members/patients.

A third critical success factor that Drs. Mostashari and Colbert cite is “event surveillance, which means physicians understanding the “flight patterns” of patients outside their own practices, as they put it. And in that context, being able to “move from the retrospective accounting of ‘leakage,’ toward prospective surveillance for high-valence events such as emergency departments and hospital admissions, discharges, and transfers,” using technology to support health information exchange for such purposes, will be essential, they note.

Finally, when it comes to the fourth vital area, the authors note that “A key difference between accountable care and managed care is that patients are not limited to a given provider, and attribution may even be retrospective, as in the Medicare Shared Savings Program. While patients enjoy the freedom to choose their providers, this limits the ability of the primary care provider to “utilization manage” the patient, and introduces the distinct possibility that the patient may migrate their care elsewhere,” meaning that patient outreach and engagement will be crucial to ACO success; and that means proactively bringing patients in for preventive and wellness care visits, the authors urge.

There are such clear implications here for healthcare IT leaders, and to be honest, though Drs. Mostashari and Colbert are focused on physician-led ACOs, most of what they write really applies to the success of any kind of ACO. And these analyses are grounded in the experiences of innovative ACOs making early strides in the new healthcare, so they are particularly valuable.

The bottom line in all this? Clearly, information technology must be used to facilitate a far broader, deeper, and more comprehensive set of communications, data-sharing, and data analysis, across all the stakeholders and care venues within an ACO—and it must facilitate far more proactive activity on the part of physicians, other clinicians, care managers, data analysts, quality and performance improvement leaders, and senior executives, in the emerging ACOs, than has been common until now.

The opportunities and challenges inherent in all of this are immense. I look forward to learning more, once Drs. Mostashari and Colbert release the “road map for physician-led ACOs” that they’ve promised their readers they’ll publish this fall. The insights to be gained could be invaluable going forward.