Incentives, Motivations Clash Under ACOs

Philip Betbeze, for HealthLeaders Media , April 26, 2013

Once you figure out your strategies and how incentives overlap, if you are considering developing a multipayer ACO, data is going to be critical. You need to have a performance management system, Perez says.

"You need to know how the entity is doing, because if you don't have midstream connections, you'll wake up at the end of the year and [you'll have] missed all these targets," he says, referencing the performance targets that commercial and government payers require ACOs to meet in order to share in financial rewards.

"You have these gainshares, but if you don't meet them, you're hosed," he says. "The way to dispel that is to put in place the machinery for the weekly or bi-monthly reporting on how you're doing."

The bottom line:

  • "You can't nail all 33 measures," says Perez, referencing the CMS ACO quality measures. "Focus on 10 or less, depending on their share of your business, and that have the most impact for your business."
  • Don't be schizophrenic—there rules are not massively different (between commercial and Medicare ACOs). Leverage your technology capabilities across the entire patient base. "Clinicians have to feel you're not schizophrenic," says Perez.
  • Focus on operational integrity and unity, because margin pressures are only going to increase.

That's the way to balance priorities and manage through the "two masters" problem.

Philip Betbeze is senior leadership editor with HealthLeaders Media.
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