"Physicians are closer to the frontlines of care delivery," Knight told me. "Physician engagement is the most critical factor in any ACO, and when physicians are running the show, it cuts down on the layers of bureaucracy that can bog down ACO operations."
Knight says an ideally structured ACO is a clinically integrated partnership that includes physicians and hospitals. He notes that hospitals have the capital to fund the significant costs an ACO requires, both at startup and for maintenance. The Dartmouth Institute study mirrors Knight's outlook, noting finances as one of the challenges that physician-led ACOs face in the future, despite some early success.
Another challenge that physician-led ACOs face is managing patients across the continuum of care. ACOs being run by doctors are less likely to include all the services—acute-care, behavioral, and pharmacy—a complex patient may need. Without these potentially key healthcare components, the gaps could exist for medication compliance and/or referrals, the Dartmouth Institute study says.
With physicians and physician groups increasing their participation in ACO models, they are extending their reach into partnerships with other care providers and payers. Strong leadership skills will be essential to navigating those relationships.