ACO Update: The Rise of Physician-Led ACOs

In the June issue of Health Affairs a study was published discussing ACO’s and the rise in physician leadership within the organizations.  One of the goals of the Affordable Care Act was to hold physicians more responsible for the care of their patients, by rewarding healthcare providers for improving the quality of care and lowering healthcare costs, the ACO model was born. Slow to start, ACOs have no risen in popularity, with more than 600 Accountable Care Organizations operating throughout the U.S.

“What is an ACO? — An ACO is an accountable care organization made up of doctors, medical groups, hospitals, and other healthcare professionals who work together to deliver high-quality, coordinated care to the patients they serve.”

— Healthcare Partners

There are many various types of ACOs, some are made up of solely primary care providers, others include a variety of specialists and others encompass hospitals and post-acute care providers. However, the study showed that physician-led structures seem to be operating best, meaning they are more likely to have complete care management programs, advanced IT programs and the most satisfied patients.

Former CMS Administrator, Dr. Mark McClellan attributes this to physicians’ personal experience and ability to identify areas for improvement firsthand and measure the impact of their efforts. The Director of the Dartmouth Institute and co-author of this study, Elliott Fisher, MD, MPH stated, “Physicians’ buy-in the payment reform is likely to be critical to the success of the health care reform.” He continued to say; “The findings suggest that physicians are taking seriously their responsibility to lead change in the health care system on behalf of their patients.”

It is certainly pleasing to know that physicians are in support of these changes and are taking on the responsibility of helping to ensure the betterment of care for their patients. As more ACOs are brought together, this report will help providers determine if the path is right for them and consider which structure is best.

To read more about how ACOs originated and to view statistics on the success some organizations have found, check out the Health Affairs blog here: http://healthaffairs.org/blog/2014/05/30/aco-results-what-we-know-so-far/

Emotions & Loyalty: Root of Patient & Physician Decisions in Health Care

People are people, whether they are identified by their career or their role in the health care process. So whether you’re dealing with a referring physician or a patient, it’s important to consider emotions, their role in the sales process and how they drive and destroy value.  One of the most valuable emotions to have in our business is loyalty. Loyalty is what providers work towards with referring physicians and what they’re trying to earn from their patients, and in a society where health care is catching a lot of heat for a lack of transparency, loyalty and honesty are key.

Lloyd Banks said, “I take things like honor and loyalty seriously. It’s more important to me than any materialistic thing or any fame I could have.” It’s funny because a lot of practices think that the best way to attract referrals is to give gifts and tip-toe through shades of gray, tickling the line of propriety and Stark Laws, whether they can afford it or not.  Matt Schneider says that when your relationships are built off of gifts however, you’re only as good as your next present. Don’t think about yourself and your service from a strictly monetary scope, consider your value, because it is more important than any materialistic thing you could provide, as long as you’re not handing out keys to new Ferraris.

In Colin Shaw’s program Beyond Philosophy, he points out that in sales, professionals brand their customer experiences with their own emotional signatures. Over 50% of a customer’s experience relies on how they feel, which will then either drive or destroy their decision path. With 20 emotions ranging from happy to trusted to disappointed to neglected; your perception of value hinges heavily on your customers’ emotions, indicating whether they will become long-term, short-term or no-term customers. In health care it is hard to look at patients as “customers” but their emotional drive is intrinsically the same.

 (See image here: http://pinterest.com/pin/177399672791761465/) 

It makes sense that in health care, more than in any other industry, emotional-selling plays a vastly important role. From a patient perspective, the health care industry is a confusing, money-hungry monster that is supposed to be able to fix the illusive medical issues they face before they die. They are operating in a state of flat out fear. Transparency in the system is a good start to helping patients sort through their emotions, aiding in their comprehension of what happens with their doctors and the bills that come out of their appointments. This is why it’s important for health care marketers and physicians to enter the conversation that patients are having already in their minds about price and quality.

The jump from reaching and making an impact on referring physicians is not all that far off as emotions go. Doctors have their own set of worries, whether it be about; patient loyalty, patients wellness, happy staff, having enough time to get everything accomplished, all while making money and keeping their practice alive.  This is especially challenging for independent physicians that don’t have the support of a hospital system.

Trends towards independent physicians getting bought out by hospital systems have cut down the number of private practices and many physicians and patients have been left wondering why hospital-owned physicians decided to sell.  The root of all patient and physician decisions resorts back to loyalty; emotional and financial support and security. With the changes that will occur over the next few years in our profession, we predict the rise of patient loyalty to independent physicians due to their ability and freedom to adopt transparency and patient-focused quality care.

If Steve Jobs Redesigned Health Care

A recent Forbes article from yesterday discussed what hospitals would be like if Steve Jobs had redesigned them in the way he redesigned the technology field. The insight was pretty much spot on and called out some pretty blatant ironies and seemingly simplistic changes.

1. Eliminate doorknobs in medical establishments. Germ theory and knob-less doors have both been around forever. 
2. Eliminate elevator buttons, cash transactions and other easily replaced vehicles for spreading germs in medical establishments. 
3. Pediatricians tell patients to avoid having their children share toys and books with sick kids.  But what do many pediatricians provide in their waiting rooms?
4. Ban bacon and doughnuts in hospital cafeterias.  Unpopular, perhaps. But how can healthcare providers preach the value of healthy diets when their own cafeterias serve so much unhealthy food?
5. Prevent sleep deprivation among physicians.  Recent focus on medical interns has led to improvements, but healthcare providers still envy the sleep rules imposed on pilots.
6. Hospital patients prefer private rooms. Hospital-borne infections prefer shared rooms.
7. Noise, visual clutter and poor quality lighting are plentiful in U.S. hospitals.  Each one has been demonstrated to harm patient outcomes.
8. Pharmacies are a terrible bottleneck in hospitals. Centralized dispensing pharmacies increase drug delivery time by 50%. Do you want your hospital pharmacist to feel rushed?
9. More talking, less walking. Nurses spend almost 1/3 of their time walking through rectangular, single corridor units to see patients. Radial units allow nurses to visually supervise patients and spend more time on patient care and communication.
10. Disease doesn’t respect office hours. Yet hospital staffing is typical of the Monday-through-Friday, 9am-to-5pm American working culture.  Studies show that patients who enter the hospital with stroke or heart disease at night or on weekends have higher mortality than midweek, 9am-5pm admissions.  It’s hard to understand why such straightforward ways to improve patientmortality outcomes are overlooked.

How these changes could be implemented in hospitals is yet to be determined, the author seems to think that the likelihood of change is minuscule because when you’re dealing with larger operations like hospital systems, small changes get lost in the shuffle. 

So it stands to reason that independent practices and non-hospital-owned physicians could be the ones that take these ideas and run with them! Working mostly with radiology practices and radiation oncology practices, the concerns associated with germs are less of an issue, but if you take the same approach, the Steve-Jobs thinking, when it comes to simplifying the larger patient issues like healthcare costs, comparing physicians and finding quality doctors; we could be on to something.

- Why leave it to patients to have to call around to eight different doctor’s offices looking for prices when you can list them all in the same place?

- Why stress about the one million and half ways to refer patients to specialists if you could do it in one simplistic portal?

- Why spend the time chasing down no-pay patients, if you can let a third party accept payment before the procedure even happens?

- Why can’t checking into your doctor’s appointment be as easy as checking into your flight online?

- If your staff is overwhelmed by various tasks that could be replaced by an application, why wouldn’t you let it happen?

Some food for thought. We’re working on those solutions and if we can fix those things, then what else can we change?