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July-August Editor's Notes: The Courageous, Not-At-All-Clueless, Pioneers of ACO Development

July 7, 2014
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The attention-grabbing headline of a blog about "clueless executives" piqued my interest, and made me reflect on the challenges facing the pioneers of ACO development today

I have to say that my attention was absolutely grabbed by the headline of a blog at this summer. The June 12 blog, by contributor Roger Dooley, was entitled, “Are You the One Executive Out of Ten Who Isn’t Clueless?” Now, who wouldn’t want to read a blog with a title like that??

What’s more, Dooley’s opening paragraph was a grabber, too. Here’s what he wrote: “If you ask executives whether they study the available data before making an important decision or just shoot from the hip, it’s likely that just about everyone will say they take the data-driven approach. A study reveals the truth: decision-makers do indeed look at the data, but only one out of ten does what the data suggests if it contradicts his or her gut feeling!” (Exclamation point Dooley’s.)

Further, Dooley went on to write, “The Economist’s Intelligence Unit surveyed several hundred international executives about their decision-making processes and reported the results in a commercial white paper: ‘Decision Action: How businesses make decisions and how they could do it better.’” As Dooley noted, only 10 percent of respondents, all senior business executives, said their decisions were driven primarily by intuition. Fully 90 percent said that they relied on data analysis, testing, and collaborative discussion, to make business decisions.

Yet when asked the question, “What do you do when the data contradicts your gut feeling?” only 10 percent responded, “Do what the data suggest.” Thirty percent said, “Collect more data”; 57 percent said, “Re-analyze the data”; 30 percent said they would “Collect more data’; and 3 percent said, “Ignore the data” (outright).

Of course, the headline did, as it turns out, slightly dramatize the actual results of that particular poll question. First of all, only 3 percent of the business executives surveyed said that they would actually “ignore the data,” whereas 60 percent would either collect more data or re-analyze the data involved. Certainly, those business executives could not fairly be characterized as “clueless,” as the headline suggested. The reality is that senior business executives across industries, and internationally, are regularly using a combination of data-driven analysis and intuition, to reach their strategic conclusions; to be honest, that’s good.

Now look at the complex policy and operational landscape these days around the creation of accountable care organizations (ACOs), as described in this issue’s cover story (which will post online this week).  Whether senior leaders at patient care organizations are considering participating in one of the Medicare Shared Savings Programs, or partnering with private health plans to create private-market contracts, they face a welter of elements to reflect on. The data, such as it is, tends to be rather inconclusive and difficult to rely on. After all, ACOs are new or new-ish creatures. No one has comprehensive data supporting all the financial, operational, and clinical/care management elements that must be considered in deciding to participate in such arrangements, because of their newness. The complexity involved in staggering.

That having been said, the leaders of pioneering patient care organizations like Heritage Medical Systems, the Mount Auburn Cambridge Independent Practice Association, Crystal Run Health Care, Steward Health Care Network, and Mission Point Health Partners, are plunging ahead, and skillfully combining vision and strategy with the intellectual and tactical flexibility to make adjustments as they go along. They’re leveraging data, but are not slaves of that data.

Really, that’s ultimately what will be required, going into these uncharted waters, filled with so much opportunity and so much challenge. Don’t worry, the provider leaders who are moving into ACO development aren’t clueless; they’re courageous. Their work will help lay the groundwork for the new healthcare of the coming decades.