ACOs Offer Physicians New Leadership Roles and Challenges

The new world of Accountable Care Organizations will focus on performance measurement, new payment models, and patient-doctor cooperation, according to Dartmouth Medical School professor Elliott S. Fisher, MD, MPH.

Dr. Fisher said ACOs are expected to dramatically shift old paradigms of health care.

“It’s not just a contract, but a journey. It’s not us versus them. It’s a partnership,” he told more than 200 physicians, legislators and industry leaders attending last week’s State of the State’s Health Care Forum, hosted by the Massachusetts Medical Society.

Unlike managed care systems that locked patients into rigid contracts, ACOs are expected to be  more flexible groups of care offering significant patient-doctor collaboration.

Ideally, they will embrace the idea that “the best fence is a good pasture,” said Dr. Fisher, in his talk, titled “How Will Accountable Care Organizations Change Cost and Quality?”

The forum, now in its 12th year, was titled “Health Care Reform: Quality, Cost, and Access – A New Paradigm.”

The challenges for physicians are formidable, as are the rewards, Dr. Fisher said.

The scope of social and technical change is enormous. New  systems will measure many aspects of physician performance and patient health in detailed ways.

Those measurements can’t be overly focused on cost,  he said.

“Consumers fear stinting (on care) and the model will be rejected if there are not measurements that are meaningful to consumers,” Dr. Fisher said.

Practices and hospitals will encounter significant technology infrastructure and organizational and training costs during the ACO transition.  The early phase of the process will be a time of failed experiments as doctors learn “what works and how to improve it,” he said.

However, physicians will have many new opportunities as they guide society through this approach to health care.

“Stewardship will become a core value,” said Dr. Fisher.  “Physicians will be partners in leadership.”

–  Erica Noonan

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