Can There Be True Accountable Care Without Clinical Integration?
For many health systems, the hardest challenge in the shift to value-based care remains unresolved – that of engaging the physician community in the journey. For those health systems that have made the considerable investment in value-based care, one truth remains: despite the systems that might have been established and the veritable army of care managers hired and deployed, patients continue to receive care largely through their relationships with physicians. Whether independent or employees of the health system, the physician remains at the center of the delivery relationship, both by law and by custom.
Pursuing the development of an Accountable Care Organization (ACO) without engaging the physician community may deepen the distrust that often characterizes the existing hospital-physician relationship. Most health systems have scars related to interactions with physicians through prior efforts like Physician-Hospital Organizations (PHO’s), scars that never truly healed. Getting beyond those issues typically requires an emotional catharsis of sorts, with an opportunity to have a dialogue with physicians and clearly articulate the case for change.
For all of these reasons, FTI Consulting recommends that the journey to forming an ACO include an organizational platform of Clinical Integration (CI). Clinical Integration is an organizing set of principles for engaging physicians in a truly physician-led, physician-driven effort to transition from volume to value-based care by reducing unwarranted variation, holding peers truly accountable for improving outcomes quality, and reducing the total cost of care. Clinical Integration, when pursued deliberately and with a sense of purpose, is the optimal foundational structure to facilitate the transition from the current fee for service environment to one that is moving inexorably to managing a defined population with accountability for both the quality and cost of care.
Forming the ACO and developing population health capabilities is likely to fall short of the goal without fully engaging physicians in the ‘why’s’ and ‘how’s’ of transforming healthcare and providing them with the tools to promote improvement. Clinical Integration provides just that opportunity.