{"id":8041,"date":"2011-04-01T09:04:17","date_gmt":"2011-04-01T13:04:17","guid":{"rendered":"http:\/\/intelihub.com\/blogtest\/?p=8041"},"modified":"2021-01-18T14:59:06","modified_gmt":"2021-01-18T19:59:06","slug":"formula-for-success","status":"publish","type":"post","link":"https:\/\/answerstat.com\/article\/formula-for-success\/","title":{"rendered":"A Formula for Success: Accountable Care + Patient Experience = Accountable Experience"},"content":{"rendered":"\n
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By Tina Minnick<\/h2>\n\n\n\n

\u201cCapitation with gain-sharing,\u201d \u201cImproving outcomes and increasing value,\u201d \u201cRevisiting integrated delivery tactics among primary care physicians, specialists, and hospitals,\u201d or \u201cBending the healthcare cost curve for managed populations,\u201d whatever your definition (in whole or in part) may be, Accountable Care Organizations (ACOs) pose a strategic opportunity for hospitals and large physician practices alike. If ACOs can overcome concerns from a Stark and anti-trust perspective and are successfully implemented, patients and ACO market leaders will see stronger physician alignment, improved quality, cost reduction, and an improved patient experience.<\/p>\n\n\n\n

What is and who will drive the ACO movement? <\/strong>The Medicare Shared Savings Program in the 2010 Patient Protection and Affordable Care Act broadly defined the ACO concept to include the many healthcare organizations across the country. While the organizational structure of an ACO is loosely defined, it does require that primary care physicians be a component. The ACO pilot program looks to work with Medicare populations beginning in January 2012, and healthcare observers agree that commercial payers will follow the Medicare lead.<\/p>\n\n\n\n

The goal of the ACO movement is that provider organizations be accountable for the value of a population\u2019s healthcare costs. Doing so \u201cwill require focused efforts to improve care for the 10% of patients who account for 64% of all U.S. healthcare costs,\u201d according to both Peter Orszag and Ezekiel Emanuel.<\/p>\n\n\n\n

The reality is that the U.S. cannot continue its current approach to healthcare delivery. Analysts predict healthcare will be one fifth of the nation\u2019s gross domestic product (GDP) by 2019, and ACOs are part of the prescription to affect cost and quality. Coordinated care that provides value and reduces cost will become the standard. ACOs will be looked upon as major drivers of reducing the healthcare cost curve.<\/p>\n\n\n\n

Both hospitals and large physician groups are prime leaders for the ACO movement. Growing market share is key for hospitals, and a strategy focused on retaining and gaining new patients will be needed to offset lower utilization. According to an article by John M. Harris, Daniel M. Grauman, and Rashi Hemnani, hospitals should \u201cfocus on retaining cases from the population that previously had been ending up in different hospitals, despite having been treated by the hospital\u2019s primary care physicians.\u201d<\/p>\n\n\n\n

Large physician practices are also likely to want to lead ACO efforts. Physicians often self-refer, and the thought of obtaining additional \u201cgain-sharing\u201d funds by reducing hospitals\u2019 census could be a motivating factor. Whether a large primary care group forms its own ACO or remains as an affiliated hospital partner, hospitals could see volume shift as primary care physicians choose alignment patterns. Domination of the market will occur by those who act and succeed first.<\/p>\n\n\n\n

Critical Success Factors for ACOs: Dominating Market Share and the Patient Experience: <\/strong>Market share is the percentage of total sales volume in a market captured by a brand, product, or firm \u2013 in this case, by a practice or hospital. The patient experience will drive brand loyalty, result in repeat patient visits, and generate new business.<\/p>\n\n\n\n

Contemplating healthcare market share can sometimes be difficult because many think \u201conce a patient, always a patient\u201d or are the only provider for a particular service or insurance type. In the past, these thoughts may have been valid, but with transparency and patients\u2019 options, provider appeal and reputation need to be top of mind.<\/p>\n\n\n\n

ACOs have to develop business plans for service area, target market, reimbursement, information technology (IT), quality, providers, and organizational structure. Each of these areas stand on its own as a major strategic decision, and execution of these plans will determine an ACO\u2019s success. Independent of these components is the fact that ACOs are designed to increase value and decrease costs; it is imperative that market share and the patient experience be critical success factors in plans to maintain or grow revenue before, during, and after ACO implementation.<\/p>\n\n\n\n

In considering where to begin, honestly answer these questions:<\/p>\n\n\n\n