5 Strategies for a Successful ACO

Friday, January 29th, 2010
This post was written by Melanie Matthews

Dr. Craig Samitt, president and CEO of Dean Health System, lists five essential strategies that can lead to a successful ACO in the healthcare industry.

The first strategy for a successful accountable care organization (ACO) is effective recruiting. We all have a tendency to fill a spot just because a spot is available. When one of our doctors leaves, we replace them with anyone who has the technical skills. The same thing occurs with staff. We are being a whole lot more selective than that. We feel that if we make the right hiring decisions in the first place, it saves us effort and turnover and we avoid staffing problems down the line.

Our second strategy is to create incentive systems that are aligned. Much of healthcare reform has to do with this as well. How well are physicians and staff and management in your organization aligned with the vision of your organization? Are we paying our staff and physicians to deliver better care at a lower cost, not just more care? At Dean, in essence, we have sought to redesign our compensation methodologies and our incentives for staff and management to deliver on better care at a lower cost.

Strategy three is about focusing on the customer. With all due respect to physicians, we have been a very physician-centric industry. Frankly, it is shifting to a consumer-centric industry. Are we delivering the product that consumers want, and are we focusing on service?

Strategy four is all about measurement. How many organizations use balance scorecards and dashboards, and how many can arm physicians with the information they need about their practices at the point of care? How many companies know how well they are doing in the service quality access arena? A June 1, 2009 article in the New Yorker by Atul Gawande talked about the differences in quality. Some of the markets that had very low quality weren’t even aware that they had low quality per the Dartmouth Atlas. How well do we share information and metrics to show how we are doing and to allow physicians to compare themselves to other physicians? For example, a scorecard that we shared when I was at Fallon Clinic compared all of the clinical units against each other for all of the elements of the patient satisfaction survey. We gave them A through F for all of the major questions. You can be sure that those departments that were getting Fs were reaching out to those who were getting As to understand what they were doing differently.

Strategy five is about reengineering processes’ and one example is the use of Lean Six Sigma. But, it doesn’t even have to be as sophisticated as that. It can just be basic process redesign. When we think of a medical home, we think of this as primary care redesign. We are looking at what we need our primary care practices to deliver on and reengineering the practices so that they make sense. We want to take our PCPs off of the treadmill that they are on and recognize what we really need PCPs to do, which is to focus on population health.

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