- Accountable care organizations (ACOs) leaders may need to boost healthcare provider engagement to foster value-based care success, a recent study in the American Journal of Accountable Care indicates.
In a case study at the Johns Hopkins Medicine Alliance for Patients, LLC (JMAP), a non-risking bearing Medicare Shared Savings Program (MSSP) ACO, researchers revealed that providers generally had a neutral or slightly positive view on the benefits of joining an ACO.
“The early experience of JMAP, an AMC [academic medical center] ACO, supports the notion that even for a relatively integrated system with experience in performance-based payment, engagement is an incremental process,” the study stated. “Limited physician engagement can be a barrier to achieving goals as an ACO develops, and significant effort needs to be devoted to educating providers on ACO goals and providing opportunities for input.”
In January 2014, Johns Hopkins University Clinical Practice Association, comprised of the School of Medicine and related physician practices, Johns Hopkins Community Physicians, including primary and specialty care outpatient sites, and two non-affiliated primary care practices partnered to establish a MSSP ACO.
The newly-formed JMAP developed a comprehensive communication strategy to inform providers and staff about the ACO’s goals as well as how the alternative payment model would affect providers and beneficiaries. JMAP conducted provider- and staff-specific webinars, practice-site “road show” visits, and clinical-, management-, and operations-focused committee presentations.
The ACO also created regional advisory councils made up of medical and administrative leaders from each clinical site to help distribute ACO information and gather feedback.
Despite a provider engagement strategy, researchers at Johns Hopkins revealed through an online survey that JMAP providers were still not aware of how the ACO impacted their practice. Between 29 and 49 percent of respondents selected the neutral response option when asked to rate their understanding of becoming an ACO and its expectations.
About 47 percent of providers also chose the neutral response when rating their comfort level with physician workflow changes resulting from the ACO transition.
As a result, JMAP providers expressed little desire to take on an organization role in the ACO.
In addition, some JMAP providers were unsure about how the ACO would improve quality of care. About half of providers (49 percent) selected the neutral response option for the question about their views on how the ACO would enhance patient care.
The study, however, showed that providers were slightly satisfied with patient care provided to chronically ill patients. Respondents rated satisfaction with patient and family communication a 3.9 on a scale of one (very dissatisfied) to five (very satisfied). The average rating for satisfaction with care coordination was 3.5 and practice teamwork was 3.3.
Despite lackluster responses, JMAP providers listed several interventions that they believed would facilitate ACO effectiveness. Approximately 84 percent of respondents stated care coordinators were likely or very likely to foster high-quality and cost-effective care within the ACO.
Other high ranking interventions included improving communication and care coordination across the care continuum (83 percent), employing support staff to enhance timeliness of test result communication (83 percent), and providing behavioral health specialists to treat mental health issues (82 percent).
Since ACOs are provider-driven models, more organizations may want to bolster provider engagement to better communicate and, eventually, achieve value-based goals, the study indicated.
“Effective engagement of providers under the ACO model is critical to motivating the care transformations necessary to improve outcomes, and it also influences beneficiaries’ acceptance of this model of care,” the study stated. “In addition to the awareness deficits discussed above, uncertainty among clinical staff may arise from possible alterations to organizational design or clinical systems that accompany transition to a more collaborative, team-based model.”
Some methods for boosting provider engagement include adding providers to shared savings distribution methods, including quality improvement as a criterion for promotion, and recognizing clinical excellence.
The survey also showed that providers may positively respond to communication and care coordination improvement initiatives.
“In response to the survey results, considerable emphasis has been placed on development of comprehensive communication tactics, as well as implementation of a more robust medical and quality strategy to support identified needs,” researchers added. “This strategy includes broadening behavioral health support, access to specialty care, and use of population-based pharmacy support.”
The Advisory Board Company found similar results from its 2015 Annual Healthcare CEO survey. Provider engagement in cost and quality improvements was ranked the biggest opportunity to bolster the healthcare system’s performance in 2015.
“Our research underscores that physician engagement is imperative to an organization’s successful transition to value-based care models,” stated Chas Roades, Chief Research Officer at The Advisory Board Company. “Driving fundamental and sustainable changes to providers’ business model is impossible without buy-in from the clinicians on the frontlines of patient care.”