ACOs operate as a company that is legally separate from any of the member providers. It operates as director of care. For example, a patient leaving a hospital can expect to be sent to a long-term care facility that is in the same ACO as that hospital. Patients are choosing the ACO and not necessarily just the hospital, which allows the hospital to more affirmatively direct discharged patients to particular long-term care facilities.

 

Only hospitals, physician groups, and a limited number of other types of providers can form and lead ACOs. However, long-term care facilities, durable medical equipment companies, and some other types of providers may join and participate in these ACOs. The federal government has suggested that it will expand the types of providers that can form and lead ACOs, but until then, other providers can still participate.

 

With major sources of referrals joining into what are essentially alliances, it is important for all providers to begin marketing themselves as capable health entities to ally with. Those that do not market themselves effectively may find competitors down the road competing more strongly through ACO memberships. Several ACOs already exist in the northeast area, and major referral sources that are not a part of these already existing ACOs have begun planning for their own eventual network. It is important to act sooner rather than later in ensuring yourself a place in these developing networks.

 

Accountable Care Organizations: Where to Start

 

Try to remember the first time you interviewed for a job: you assessed your strengths and weaknesses; you tried to articulate your aspirations in the short, medium and long term; you researched the interviewee and the potential employer.  In short, you prepared for a discussion about how and why the potential employer and you were a perfect match.  

 

Accountable Care Organizations present the very same challenge - how to persuade the ACO that your organization is a perfect match with the ACO.  A huge difference between an  ACO and potential employers of yesteryear is an ACO constitutes more than just one organization. Sure, the ACO is a legal entity; however, it's the creation of a joint effort between two or more health care providers. An ACO will be very selective as to any provider/supplier with whom it contracts unless it controls and/or owns the provider/supplier.  

 

An ACO will demand that all providers/suppliers with which it contracts have a compliance program that protects the ACO and integrates into the ACO's compliance program; that providers/suppliers have clinical pathway protocols as well as data collection and management systems among many other things.

 

Where to start? A thorough self-assessment - a situation analysis - is the starting point: who, what, when, where, why and how. That's the starting point for business and marketing plans. That's the starting point for preparing for participation in an ACO.  Your first job and an ACO have one thing in common:  you must know yourself and your organization well enough to persuade a decision maker that the synergy is there to work together.