Physicians: The Quarterbacks of an Accountable Care Organization - Cover

Physicians: The Quarterbacks of an Accountable Care Organization

At the end of January, CMS announced that 25% of participating ACOs (MSSP) had saved enough money to receive bonus payments, but 72% of those that received payments were physician-led ACOs. Now that is interesting!

Why would physician organizations be “more successful” (up for reader interpretation)? Are they catching on to something that their counterparts just don’t quite understand? How do technology and solutions play into what physician ACOs are doing?

Combine these questions with the fact that physician ACOs are starting to outnumber hospital or health-system ACOs (see chart below), and KLAS just had to begin research in this area. The results of that research were recently published in the study Physician ACOs 2014: Variations on the Accountable Care Theme.

Chart showing ACO formation by type

Types and Characteristics of Physician Quarterbacks

After analyzing the physician-led ACOs that responded to the study, we saw that they naturally fit into one of three quarterback, or physician, types: the Medical Group, the Partnership (i.e., connections with hospitals perhaps, yet still led predominantly by physicians), and the Association (i.e., IPA or independent physician association). Each has its own unique characteristics that define its strategies. For example, Medical Groups tend to be on a more standardized EHR platform, whereas Associations are much more heterogeneous when it comes to EHRs. Associations’ and Partnerships’ risk agreements have a much higher percentage of Medicare ACO (MSSP) arrangements, while Medical Groups rely more on Medicare Advantage and/or commercial setups. The one common thread among all of these types is that the entity filling the quarterback role is the physician.

Wide Array of Supporting Tools and Technology

This should be simple. You have EHR vendors, population health management vendors, HIE vendors, care-management or care-coordination vendors, patient-engagement vendors, and more. Okay, maybe not “simple.” These days, and based on observations I made at recent healthcare IT conferences, it almost feels like you can pick a vendor, any vendor, and find “population health” or “ACO” somewhere in their marketing material. This simply goes to show how strong a trend accountable care is in healthcare technology—and everyone wants to get their piece of the ACO or population health pie.

That said, it is clear which vendors had the most mentions in our ACO report when it came to technology being used. eClinicalWorks and Epic were the most mentioned players on the EHR-vendor sideline, and Optum and Phytel were the most mentioned players on the third-party or best-of-breed sideline. In total, over 30 different vendors were mentioned by the physician-led ACOs interviewed, a fact that only fortifies the saying, “When you’ve seen one ACO, you’ve only seen one ACO.”

Where’s the Clock?

So what’s your guess for what the game’s time clock reads? Did we just start the second quarter? Are we at halftime maybe? Or are we on the downhill stretch to the end? Some of you may be thinking that we’ll never reach the end of the game. I don’t have the answer to this question. However, what we do know is that change is coming and provider organizations are preparing. And when it comes to not only preparation but also execution, the quarterbacks seem to be making the right calls.