Physicians Plan for Role as Captains on ACO Ships

Abstract

M any long-term care physicians are wondering what life – and practice – might be like in the world of accountable care organizations. While this care-coordination model is still evolving, its physician-driven, patient-centered nature suggests that LTC practitioners can expect to take leadership roles and promote quality care. “I can say on behalf of physicians that we don’t tolerate uncertainty well.” Dr. Mark Werner, chief clinical integration officer, Fairview Health Services, Minneapolis, said at the Third National Accountable Care Organization Summit. “We have to figure out this journey together.” Dr. Werner identified several changes that physicians will need to address on the journey toward participation in accountable care organizations (ACOs). For example, he said that physicians must “share success at all levels.” He explained, “You can’t have a successful ACO if physicians see themselves as employees. They must see themselves as owner-operators.” This leadership role will be new for many physicians, said Dr. Werner. “It will be a challenge for physicians to move from being expert leaders to being process leaders.” Dr. Justine Carr, chief medical officer and senior vice president of quality and safety at Boston-based Steward Health Care System, said that it will be necessary to identify emerging leaders and nurture them. “I can’t emphasize enough the importance of having leaders emerge from the ranks,” she said. “Invite them into big-picture venues. Make sure they have the tools and staff they need. Teach problem solving and ... system solutions.” She added that rewards and recognition are important to motivate these emerging leaders. ACO physician leaders will “need to have a clear, compelling vision of the future and better systems of care,” said Dr. Randall Williams, chief executive officer of Pharos Innovations in Northfield, Ill. “They will need the ability to inspire colleagues and enable change. They must be able to align ‘what’s in it for me’ with organizational goals and objectives.” More than ever, he suggested, physicians will “need financial acumen and a clear understanding of how dollars flow in and out. They will have to be able to identify targeted areas of efficiency and how to move the organization toward those.” Dr. Williams said that physician leaders also will have to understand how to build organizations and be able to translate business goals and objectives into operational structure. With a growing drive for improved outcomes and processes, he said, physicians must be able to analyze data from many sources and use the results to identify opportunities for improvement. The patient-centered nature of ACOs also calls for an evolution in physicianpatient relationships, Dr. Werner said. “Physicians typically listen to diagnose. That is different from listening ... to have a comprehensive understanding of the person’s needs. Physicians won’t be able get to make decisions and walk away from outcomes,” he said. Physicians also will have to deal with patients who may be more informed and demanding, Dr. Werner suggested. For instance, he observed that patients increasingly say that they want care based on evidence. “They are becoming aware that there is an evidence base to some parts of health care. We have to find examples of new care models in our communities and use them.” According to Dr. Werner, “At the end of the day, what we are trying to do is create new clinical systems.” This, he said, requires organizations that “plan to train and mentor physicians on an ongoing basis. We need to embed physician training into work and tie it into what the organization is doing.” CfA