Start Your ACO at the Very Beginning, a Very Good Place to Start

This memorable line from the “Sound of Music” offers good advice to the newly starting ACO. In fact, a good place to start applying your ACO data is in continuous individual improvement with your physician board members. A leadership group that is fully engaged in measuring and meeting the key performance indicators for quality and cost will inevitably lead to better outcomes and financial success. Most doctors are naturally competitive, wanting personally to confirm their high performing status. Opening each physician leader’s data to themselves so that they can see their personal performance, compared with themselves, quarter over quarter can be clinically life changing. Once the board is fully engaged, the ACO can then leverage this experience with the rest of the provider population. A fully engaged board of physicians that are willing to look at their data and move toward personal practice improvement is “priceless.”

Additionally, being able to confirm the accuracy and value of your data with the doctors in leadership, who hold significant influence over the provider group, will reduce unnecessary data challenges in the future. Your information system should be able to provide risk-stratified patient data updated monthly. This will help reduce the timeless argument that “my patients are sicker than your patients.” CMS uses the hierarchical condition category (HCC) scoring methodology, so it makes sense to stay within their formula. Remember, we are looking for incremental individual provider improvement quarter over quarter. So the importance of having a board made up of steady, data-driven, high performing, fully engaged practitioners should be clear.

It is a solid principle that physicians will generally listen to other key community-based physicians in making changes in their own practices. Using data wisely will ultimately and favorably affect the success of the ACO. Administrators, regardless of competency, or well-intentioned objectives rarely have sufficient passport to get that piece of the work done. In many situations there seems to be a historical mistrust of administrators among physicians. It is important that until a degree of passport is established, the ACO will need peer to peer conversations over the sensitive matter of clinical performance. Keep in mind, the objective is to use the financial and clinical data to compare each provider with themselves. Incremental improvement will move the ACO toward sustainable success. Establishing excellent data-driven clinical performance measures with the leadership then becomes an important early application of the ACO data, a choice that becomes another decision well made.

Craigan Gray

About the Author

Craigan Gray, MD, MBA, JD

Dr. Craigan Gray, Salient Healthcare’s Chief Medical Officer, brings rich experience from private practice, hospital leadership, and governmental health-benefit programs. Prior to joining Salient, Dr. Gray was director of North Carolina’s $12 billion Medicaid program. His time as VPMA at Bon Secours Our Lady of Bellefonte Hospital in Kentucky was distinguished by moving the facility into the top-quality performance tier for Health Grades and CMS health quality indicators. Dr. Gray is a Stanford University trained Obstetrician/Gynecologist. In addition to an MD degree, Dr. Gray holds an MBA degree and a JD degree. He is a Certified Physician Executive and is published in various medical journals.

Leave a Reply

Your email address will not be published. Required fields are marked *