Baylor Health Care System believes that an accountable care organization (ACO) should start with a conviction that every aspect of the organization should be devoted to serving patients.

As described in a case study in the Spring/Summer 2011 Leadership report, Baylor Health Care System is working toward becoming an accountable care organization (ACO).

The health system developed the following 12 ACO must-haves that focus on people, quality, and finance.

Effective and Shared Governance

  • Preserved community interest
  • Physician buy-in
  • Discipline and process respect
  • Consequence management

Aligned and Efficient Clinical Workforce

Increase our capacity to serve. This is about population health. Reach beyond clinic and hospital walls to promote patient compliance with care and systems. Promote team care.

  • Sufficient primary care capacity
  • Right-sized and responsive referral network
  • Employed private practitioner balance
  • Clinical hierarchy/active physician leadership

Informed and Skilled Participants/Workforce

  • Education and culture shift
  • Lean manufacturing/continuous quality improvement business plan development

Interoperable, Data-Enabled Environment

Adopt health IT using web-based clinical tracking, visit planners, population reports, and electronic medical records that match program goals and clinical measures with our health information exchange.

  • Collaborative database design and management
  • Active security and data reliability management
  • Real-time influence
  • Flexibility/accommodating disparate data sources
  • Active disease management patient registries


Develop measures of health care for which current data are inadequate. Develop processes and measures to improve adherence to patients' wishes in providing care at the end of life. Promote transparency through development of internal and external websites and other materials that provide comparative quality information.

Attribution, Assignment, and Capacity Management

Increase our capacity to serve. This is about population health. Eliminate racial and ethnic disparities in health care, and in access to and utilization of health care.

  • Attribution methodology
  • Increased access speed within an episode

Anchored Patient-Centered Medical Home

Know who the patient is, track them through the continuum, and design a route based on their needs.

Care Coordination and Patient Compliance

Acknowledge the shift from today's practices to system thinking. Find patients medical homes.

  • Centralized and backup appointing
  • Site-of-care management/self-care support
  • Special population skills
  • Reduction of preventable readmissions
  • 20-80 rule intervention skills

Risk Assessment and Acceptance

  • Actuarial support
  • Managing risk along the timeline

Cost Monitoring and Reduction

Reduce the annual rise in healthcare costs to no more than the growth in the gross domestic product by 2015. Reduce waste, such as duplicate tests and duplicative data gathering.

  • Require plans to reduce unnecessary administrative costs
  • Management reporting systems/utilization review

Provider Reward Methods/Incentive Design

Use what works: asymmetric ACO, symmetric ACO, partial capitation

Sustainable Business Structure

As the provider, see the patient, payer, and employer as partners. Promote trust through transparency. Agree to leave no partner behind.

  • Contract for shared savings
  • Contract for risk
  • Receive and distribute rewards
  • Plug and play partnering capabilities

The 12 ACO must-haves are reprinted with permission from Baylor Health Care System.

For more about Baylor's ACO journey, access the related case study in the Spring/Summer 2011 Leadership report.

Publication Date: Thursday, June 23, 2011