Accountable-care organizations (ACOs) are likely to assume multiple forms, but no matter which model they opt to follow, radiology practices and imaging centers must adopt a strategic, business-oriented approach to selecting the organization or organizations with which they wish to ally themselves, as well as to securing their positions as ACOs’ imaging providers of choice.
Involvement on the ACO front is a process that begins with clear and vigorous articulation of the near- and long-term value propositions for patients, the ACOs in question, and the ACOs’ other participants. Along with exercising persistence in pursuing ACO relationships, being able to articulate those propositions is the key to “getting a seat at the table,” according to W. Kenneth Davis Jr, JD, a partner in the Chicago, Illinois, office of law firm Katten Muchin Rosenman LLP.
During “Setting Up an ACO: The Good, the Bad, and the Ugly,” a panel discussion held on July 22, 2011, at the RBMA Executive Education Program in Scottsdale, Arizona, Davis advised imaging providers that they cannot go wrong in selling high-quality services and patient care as a component of the value proposition. Promoting such high caliber, he says, entails setting patient-care and practice-management benchmarks and ensuring—through careful tracking and monitoring—that they are consistently being met. It is even more significant that it means harnessing IT solutions and analytics to keep a tight rein on utilization management, so that efficiencies can easily be demonstrated to prospective ACO partners.
Moreover, such an effort involves the implementation of an order-entry solution with a decision-support component as an overlay on the utilization-management piece, as well as the integration of the PACS/RIS and electronic health records systems to provide a detailed picture of patient-care outcomes. Coordinating the use and flow of images and information within the care environment is essential.
Davis advocates thinking like an investment banker, determining (from the wealth of available information contained in integrated and coordinated systems) the flow of patient care and resulting reimbursement, various costs and benefits, and where true economic and clinical value propositions can be found.
Recognizing the different roles that radiology practices, imaging centers, and hospitals play in the ACO sphere is equally important. Davis deems it critical for those attempting to become part of an ACO to debunk the widely held myth that radiology is more of a cost center than a revenue producer. Demonstrating that outpatient imaging centers are fundamentally less than their hospital-based counterparts are to operate goes hand in hand with this step. Such tasks, according to Davis, can be accomplished via comparison of costs incurred and benefits achieved with industry benchmarks.
The Right Fit
No matter how attractive the value proposition offered by a given radiology provider might be—at least, from the perspective of its own management—it might not be the right fit for every ACO prospect. Comparing the analytics-backed value proposition with the goals and objectives of the prospective partner therefore remains a prerequisite to forging any ACO agreement, Davis states.
“On one hand, it is important to have a strong sense of self and the value proposition one’s organization brings to the table,” he explains. “On the other hand, be realistic.” The proposition of value for the ACO itself, the patient population, and the payors does not always mesh with a given ACO’s objectives and needs. While there is likely to be a good fit for all parties involved in ACO-related endeavors, leaders must use actionable data—not only to highlight value, but to vet the ACO match.
Julie Ritzer Ross is editor of RadAnalytics.com