Chris MillerHaving worked in recent years through the bureaucratic and legal requirements necessary to becoming an accountable care organization (ACO), provider organizations now must get serious about keeping a tightened rein operationally. Entering the new world of accountable care means that, over time, providers must begin to demonstrate improved care outcomes as the extent to which they are truly accountable for their patients’ outcomes becomes increasingly scrutinized. Meanwhile, the path to full ACO readiness can be fraught with unforeseen risks that will shape outcomes for better or worse.

Typical assumptions at the start of the journey to accountability in a value-based care delivery system include the following:

  • Payments will be fixed for a community pool of individuals (i.e., billable/chargeable services are no longer the core of the hospital or practice accounting system).
  • Any operational overhead that is deemed unnecessary must be eliminated (i.e., so-and-so must be trimmed).
  • Internal agendas must be aligned (i.e., each enterprise component contributes, or not, to the overall success of the health enterprise).

As a consultant, I’ve had the opportunity to support provider clients in their ACO project development, some representing multiple hospitals with service areas spread across hundreds of miles, and with varying levels of market dominance. Through these engagements, I have learned that even with the highest organizational commitment and the real opportunity for significant cost savings, these projects can quickly be undermined by stakeholders and project participants who view the projects as a threat to their own positions and futures within the organization.  In such circumstances, looking to one’s own personal interests over the needs of the organization is an unfortunate and all-too-common aspect of human nature. Executive leaders should not underestimate this real and substantial risk area as they consider forging ahead with an ACO strategy.  

In my experience, three important elements have proven time and again to be critically important in fostering an environment of organizationwide commitment for an accountable care project and ensuring that the project truly achieves the goals of continued care accountability, clinical care quality improvements, and an overall environment of standardization that results in significant cost containment. These elements are: 

  • The willingness of top management both to strongly promote the strategic vision by providing direction and setting specific outcomes expectations with all levels of the organization’s management, including lower level managers, and to play an active role in engaging senior physician leaders in the structuring and review of quality of care improvements (driven primarily by nonclinical organizational processes)
  • The engagement of an experienced  project manager who possesses both the right skill set (e.g., a consummate communicator) and the strength of conviction to champion a correct path for the ACO 
  • Organizational patience to allow ample time to define and structure the required metrics and processes, including recruiting the right personnel to successfully execute the project

Organizations embarking on an ACO development strategy that lack these critical elements of success face uncertain outcomes. In the worst case, the organization may become overcome by project difficulties, employee resistance, and inadequate executive and project leadership and decide to call it quits, walking away from an opportunity for significant healthcare cost savings.  

In short, organizations should consider this simple lesson: No matter how big or sophisticated your IT project planning, your organizational stakeholders are fallible and can derail a project if the potential project risks are not identified, acknowledged, and addressed at project onset.

Chris Miller, MT (ASCP), MSSM, is senior delivery manager and EACOE enterprise architect, CTG Health Solutions, Buffalo, N.Y.


Publication Date: Monday, March 24, 2014