When it comes to accountable care — and managing risk — there’s no one-size-fits-all model. In fact, the journey toward creating a viable healthcare community is sure to differ across organizations, patient populations and regions. To determine the right approach, providers must do their homework, understanding the various models of accountable care vis-a-vis their needs and goals as an organization. And even though there’s no quick fix, rewards will come to those providers who take the time to assure the proper fit over the long haul.

Here, then, is a signpost for organizations seeking direction as they stand at the crossroads that defines accountable care.

Don’t Go It Alone

As providers navigate episodic care, enterprise-wide clinical and financial perspectives, and population care management, they’ll want to surround themselves with experts. At this point, the provider might choose to elevate the conversation to selecting a partner/vendor who will walk the accountable care journey with them. Questions to ask of prospective vendors:

  • Does the vendor truly have the ability to support our organization’s goals? Do they have the domain expertise and competence to help us succeed?
  • Does the vendor have the ability to assume and manage risk? Do they have a solid track record in managing risk?
  • Can they augment their tools with expertise and proven best practices?
  • Are they strategic in their thinking, with a reputation for delivering flawlessly on execution?

Take a Hard Look in the Mirror

“Know thyself,” an adage attributed to Socrates, is said to be at the foundation of all knowledge. And the ancient two-word imperative continues to have relevance today, particularly as providers deliberate the future course of their organizations.

To determine the most appropriate and sustainable accountable care model, providers must put themselves under the microscope. A comprehensive readiness and materials assessment not only will improve their understanding of strengths, but identify and illuminate gaps in preparedness.

Things to consider when conducting the assessment:

  • Analytics and data sharing. What is the state of our infrastructure for a care network? Are we equipped with the integration and interoperability to manage clinical and financial risk across the continuum, from the practice to the patient’s home?
  • Service lines. Can we manage costs and deliver quality under existing clinical service lines. What do we do well and what needs to change? And where do we need to seek partners?
  • Care coordination. How well have we made the shift from discharge planning to hard-wired care coordination and care management?
  • Consumer engagement. How should we be engaging patients as partners in their own care (to improve outcomes and reduce costs), while also working to support physicians in this endeavor?
  • Connectivity with community pharmacists. Are we leveraging the potential of our community pharmacists (via data and analytics) to improve the coordination of care across stakeholders?
  • Culture change. Once we choose an accountable care model, how will we incentivize employees to embrace it? How can we design employee benefits to test risk sharing internally, then apply that learning in the marketplace?

With this level of visibility in hand, providers can begin to step thoughtfully forward, examining and customizing the accountable care model that’s right for them.

Review the Models

Several emerging models of accountable care enable providers to assume varying levels of risk and reward, while calling on them to tailor shared saving arrangements based on demographics and circumstances. They fall into three general categories:

  • Payer-led, in which payers provide a turnkey path for providers to become Accountable Care Organizations (ACOs).
  • Payer-enabled, in which regional payers provide support for analytics, care management and administrative functions.
  • Provider-independent, in which providers remain independent of payers, but are better-positioned to partner with those of interest.
  • Providers will benefit from taking the time (or seeking counsel) to understand the pros and cons of each.

Stay Nimble

Even with their readiness assessment and ACO model of choice in hand, providers still will face a future fraught with unknowns. Yet there’s really no choice but to hammer out a vision and begin moving the organization toward it. And remember: this isn’t a sprint; it’s a multi-year marathon toward transformational change.

If there’s one additional bit of advice for those blazing this risk-sharing, accountable care trail, it’s this: stay flexible. Commit to your strategy, even as you cultivate the ability to anticipate and react to change. Select a vendor partner that can walk the path with you, supporting your needs for health IT and expertise. Neither a canned approach nor a rigid structure will win this race; winners will be those who are aware, informed and adaptable.

Rose Higgins

About the author

Rose Higgins is vice president of Payer/Provider Solutions for Studiomaca. In this role, she is responsible for leading the Studiomaca Technology Solution (MTS) business units and Studiomaca Corporate Strategy in architecting a cross-portfolio approach to designing and delivering market-leading, community viable products and programs. Ms. Higgins also oversees the accountable care strategy for MTS.