With ever more data demonstrating that patient-centered medical homes are the core of successful ACOs, it’s becoming clear that primary care physicians can have a meaningful role in the accountable care movement. In fact, primary care physicians have the opportunity to lead ACO development.
Some primary care physicians have stepped up to leadership and have been very successful. Others want to but don’t know where to start, because there is no precedent for this.
So, what’s required to make a primary care physician a successful ACO leader? It begins with these five fundamental steps:
1. Be the most prepared person in the room. Before you lead, you must understand. And understanding ACOs isn’t a lengthy process. You truly can become one of the most knowledgeable people about ACOs in a matter of hours, not weeks. As you start developing an ACO or collaborative care initiative, your knowledge and positive informed contributions will earn you the respect and confidence of others – foundations upon which leadership rests.
2. Get out of your silo. Accountable care is a team game. Be part of that team by networking intentionally with other primary care physicians, specialists, and hospital administrators. Seek out ways to interact. There is a window of opportunity for the physician willing to bridge gaps.
3. Exercise quiet leadership. There is no need to seize the podium and tell others what to do. That will backfire, of course. Facilitate discussions, and ask others leading questions to find out what they think. Convene breakfasts with members of the medical staff in your community. Engage hospital leadership. An informed primary care physician ACO champion soon will be a much-desired commodity. Lead from behind, as it were. Your goal is to increase awareness and buy-in to a vision, and ideally, it should be the group consensus. You do not need or want to be getting the credit.
4. Do the due diligence. Find out what is going on. What’s out there in your market? Are there medical home networks forming ACOs in your state? What is Medicaid considering? What are the private payers considering?
5. Be wise about who will welcome your leadership. Start with public and private payers. They want higher quality at lower cost, and they’re coming to understand the advantages of the medical home–centric ACO in achieving these goals. Thus, they’re more open to primary care medical home leadership. Enlightened specialists and hospitals are embracing primary care leadership for the same reason. They want to ride the winning horse, and the medical home–centric ACO is often that choice. Others who aren’t as enlightened won’t welcome the loss of control and will resist.
Will leadership be worth it? In our experience, primary care physician leadership has clearly been worth it to those physicians who pursue it, for four reasons. First, their ACO or collaborative care organization is more likely to be successful. Second, their ACO’s savings pool is bigger, and its outcomes are better. Third, they’ve enjoyed restoring the multispecialty collegiality from their days of medical training. And finally, their contributions have been more valuable – and the ACO payments to them based on contributions have been correspondingly more substantial.
Mr. Bobbitt is a senior partner and head of the health law group at the Smith Anderson law firm in Raleigh, N.C. He has many years of experience assisting physicians form integrated delivery systems. He has spoken and written nationally to primary care physicians on the strategies and practicalities of forming or joining ACOs. This article is meant to be educational and does not constitute legal advice. For additional information, readers may contact the author at bbobbitt@smithlaw.com or 919-821-6612.