by Jaan Sidorov
First posted on Disease Management Care Blog 2/18/2014
The Disease Management Care Blog was quoted in Software Advice‘s article on how primary care practices should join accountable care organizations. While regular readers won’t be surprised by the DMCB’s underlying skepticism about ACOs, this article does a nice job of introducing the topic of “risk transfer.”
As the DMCB understands it, risk transfer is a contractual agreement to exchange money for risk. In the instance of ACOs, provider organizations are agreeing to accept risk in exchange for a piece of any savings that accrue from managing that risk. If it sounds like doctors are adopting many of the features of insurance companies, you’re right. Whether they also adopt many of the bad behaviors of insurance companies remains to be seen.
What the ACO wasn’t aware of was data suggesting that the price of admission to the money-for-risk game can range between $11 and $26 million. In order to get a return on that kind of investment, physicians are going to have to figure out how to manage down a lot of admissions, specialty referrals and procedures.
At any rate, according to Profitable Practice, five elements that a primary care practice should look for in gauging an ACO partnership are:
1) Teaming: the presence of (nurse) care teams armed with protocols, plus strong internal quality improvement systems.
2) Physician-led: visible and smart physician leadership who understands health reform
3) EHR: A functioning and organization-wide EHR
4) Patience: Practice change will take more than a year. Learning collaboratives can help.
5) A Mirror: docs need to ask themselves if there is a willingness commit special attention and time to high cost, chronic conditions that generate hospitalizations, repeat visits and costly procedures. Non-physician providers will be able to do the routine care, while it will be the physicians who will need to spend day after day with complex patients.