“Not by Bread Alone:” ACO’s Need More Than Data to Survive and Thrive

This quotation from the ancient biblical text (Deuteronomy 8:3, Matthew 4:4) offers good advice in the modern world of Accountable Care Organizations(ACO)–it takes more than data to make an ACO successful. Usable data is available to the ACO leadership and participants these days.

Any number of reasonably-priced data management and analytical systems are on the market. There is no excuse for any organization to be struggling along, working off of an Excel spread sheet. The fact is, the most important elements of a successful ACO are the relationships established as part of the organization.

In an environment where technology is emphasized, it is easy to forget that people still do the important work in health care. It is true that providers of all types may be guided by data; nonetheless, health care is still a very personal transaction. Important too are the interpersonal relationships between providers that facilitate clear communication about a patient’s care. So where does this all begin?

One of the more important people in the ACO is the medical director, the physician who meets with doctors personally laying out the data showing their performance status. Systems like Salient’s Dashboards make it fast and easy to demonstrate a doctor’s performance in any number of key performance indicators. Additionally, this data is easily exported into Excel and sent by e-mail; however, until a provider fully understands where improvement is needed and how to get there, the personal visit is crucial in building confidence and trust in the data. Keep in mind that all of us feel some level of insecurity with new situations until we have developed some useful understanding of the process. Some providers need more encouragement than others, so that is why the personal professional relationship is important.

The ACO concept is a community-driven population-management system. While it is true that the ACOs do not need the hospital to function, this facility is still an important piece of the health care delivery system. Hospitals, once the “center of the health care universe,” are now a cost center. The old motto “keep them sick and keep them coming” is now “keep them well and keep them out.”  Many hospital leaders are struggling with his new paradigm. The ACO has real data showing the value of well-managed post-acute care transitions that can be invaluable for the hospital’s bundled payment scheme. Nonetheless, the hospital leadership must trust the ACO as much as they trust your data, thus the value of a personal professional relationship.

Perhaps the most important personal professional relationship in the ACO process is with the patient. It does not help to know that the ACO practice has 24 patients with COPD without  Pneumovax protection unless each patient is personally contacted to come into the office and get the vaccination. Being available by phone and keeping the office open on Friday afternoon to keep patients out of the emergency room over the weekend is another part of that responsible personal professional relationship. Having transitional visit appointments available to manage the shift from hospital to home is another key element. It is the balance between data and relationships that will lead to financial success for the ACO and outcome success for the patient.

At any point that we think we can thrive on data alone, we might as well “tell them to eat cake,” and we all know what happens next.

Craigan Gray

About the Author

Craigan Gray
Chief Medical Officer, Salient Management Company

Prior to joining Salient as Chief Medical Officer, Dr. Gray was director of North Carolina’s $12 billion Medicaid program. His time as VPMA at Bon Secours Our Lady of Bellefonte Hospital in Kentucky was distinguished by moving the facility into the top-quality performance tier for Health Grades and CMS health quality indicators. Dr. Gray is a Stanford University trained Obstetrician/Gynecologist. He also holds an MD degree, an MBA degree and a JD degree. He is a Certified Physician Executive and is published in various medical journals.

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