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Who’s Delivering Accountable Care?

The people and organization aspects of accountable care enterprises


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Health care’s brave new world
In today’s changing health care environment, provider organizations face intensifying pressure to reduce costs and improve quality of care. To make progress on these divergent goals health care provider organizations, including hospitals and health systems, should develop new ways of integrating with physicians and other clinicians and delivering care to patients. In light of this, many provider organizations are currently exploring the benefits of transitioning to an accountable care enterprise. Accountable care enterprises seek to improve quality of care while reducing costs through clinical integration and value based payment with increasing assumptions of risk to drive sustainable population health management. The goals of clinical integration are to enhance coordination of care and advance evidence-based practices to reduce errors, improve safety and avoid financial penalties. The goals of payment model transformation are to align payments with performance and create a sharedrisk provider environment. Working toward these goals requires careful consideration of the people and organization aspects needed to successfully establish an accountable care enterprise. 

While accountable care models may take on many different forms, each should be based on organizational alignment. The enterprise should find a way to link individual clinician and organizational goals, for without this linkage an organization would be an accountable care enterprise in name only. As a result, people and organization considerations are critical to achieving the enterprise’s goals regardless of the type of structure pursued. In this paper, we explore the key considerations for leadership, decision making, organization model and the talent and change management implications of a new way of delivering health care. We suggest important factors to examine in considering the implementation of an accountable care model and discuss how health care providers can assess their own readiness for change. 

Leading the new world
Transitioning to a new way of delivering care is not an easy task. Effective transformation to an accountable care model will require that leaders drive physician buy-in and acceptance. Above all else, physicians and other clinicians, such as nurses, nurse practitioners and administrators, need to be agile leaders who are ready to drive change. Additional areas in which new leadership capabilities will likely be required include risk management, performance management, financial and clinical acumen, collaboration and teaming.

Provider organizations should create new leadership development strategies and recruiting strategies based on the needs of the accountable care enterprise rather than those of the existing model. To do so, they should assess leaders’ current abilities and develop a competency model that outlines the capabilities required to operate in an accountable care model. By analyzing the gaps between the current competencies and those required for the future, they can create development programs to help leaders close those gaps and they can identify recruiting needs.

In creating leadership development programs, provider organizations should plan to incorporate real experiences that are tied to the business objectives of the accountable care enterprise. While leadership capabilities can be based on theory and formal learning, they are developed primarily through actual experience. The “see one, do one, teach one” approach commonly used in medical schools can be a very effective method in a leadership context as well, especially when bolstered by coaching, mentoring and formal training.

Physician and other clinical leaders may need to stay close to their practice, so providing them with the right leadership experiences can require creativity and flexibility. For example, a physician leader could shadow a leader in another service line or serve as a liaison to other areas of the provider organization. Rising leaders can also be assigned to special projects, such as quality improvement initiatives, which can provide a forum in which to practice leadership techniques. Regardless of what the specific opportunities are, they should be tied to a clear path for rising through the organization. Creating this path will provide both the imperative and the space for rising leaders to partake in these experiences.

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