Docs may be best ACO leaders, but significant weaknesses remain
Staff are more receptive if being led by a boots-on-the-ground leader, not someone sitting in an administrative office
A new study provides even more evidence that physician leadership is the key to success with accountable care organizations.
Conducted by researchers at Dartmouth and University of California at Berkeley, the study -- published in June's Health Affairs -- examined the landscape of public and private ACOs and determined that some 51 percent were spearheaded by docs. Another 33 percent were headed by hospitals and docs.
These numbers are important, as researchers point out, because strong physician leadership carries with it improved communication with clinicians and staff and ensures that the patient needs are taken into account when ACO decisions are made. Trust is built, and staff in turn often are more receptive as they're being led by a familiar face, a boots-on-the-ground leader, not someone sitting in an administrative office off-site.
[See also: Are physician-led ACOs superior to hospital-run organizations?.]
An estimated 18.2 million people in the U.S. currently receive care via public and private ACOs. So, the lion's share of these ACOs have physicians at the helm, which researchers point out as beneficial, but several limitations remain. Physician-led ACOs typically struggle with the care coordination piece of the puzzle.
"To achieve coordination across providers, ACOs require clinical, administrative and technological cooperation not only among physicians but also with other providers beyond the walls of typical physician practices," researchers wrote.
There's also the cost piece. ACOs are neither an easy nor an inexpensive undertaking, requiring a significant investment on the part of the provider. And when providers are already strapped for cash, starting, spearheading and funding an ACO is no walk in the park.
Moreover, achieving the very nature of what an ACO is -- a value-based model that examines quality outcomes versus the traditional fee-for-service model -- proves a difficult challenge for the industry. For instance, still about 50 percent of ACOs are unable to monitor quality performance indicators and extend subsequent feedback to clinicians on these metrics. Regarding financial performance, only a third of ACOs reported monitoring financial metrics.
Overall, ACOs are complex by nature. Success is contingent on myriad factors at play, one of the most important being strong physician leadership. "It seems likely that the challenge of fundamentally changing care delivery as the country moves away from fee-for-service payment will not be accomplished without strong, effective leadership from physicians," the study states.
