6. Failure to engage patients in care management.
Patients need to be a key part of the care team and educated to take responsibility for their health and healthcare. Unfortunately that's not a skill that seems to come naturally to either hospitals or physicians.
7. Failure to have contractual relationships with cost-effective specialists.
Specialists and patients will not be limited to a single ACO so referral relationships will be very important in terms of overall ACO performance. Shortell said PCPs may need to reexamine their entrenched relationships with high-cost specialists that don't produce the quality improvement measures necessary for a successful ACO.
8. Failure to navigate the new regulatory and legal environment.
Compliance with new regulatory requirements will require new levels of transparency and cooperation among hospitals, physician organizations, and payers. Lawyers need to be involved.
9. Failure to integrate beyond the structural level.
Structural and contractual relationships may be in place on paper to provide more coordinated care, but if behavior doesn't change, then the structure is meaningless. Improvement will require engaging all of the healthcare professionals along the care continuum in the process.