Approach: Leadership

Governance Model Issues

Structures that are optimized for the out-of-the-box thinking and consensus building needed for early ACO formation are not ideal for decisive, rigorous management for a mature ACO in a competitive environment.  Therefore, new ACOs should consider a transitional model, with a structure that is defined for a formative period, with a plan to create a different structure at some defined point in the formation process.

ACOs should also consider the role of patients/members in governance.  In the future, ACOs may decide to explore the formation of health care “cooperatives” envisioned in the health reform legislation.  If so, established representation and involvement by patients who would become members of the such a cooperative would be helpful.  Furthermore, the efforts of an ACO to improve efficiency and reduce unnecessary or cost-ineffective utilization could raise concerns among stakeholders about the need to balance advocacy for individuals vs. stewardship of resources to serve population.  Involving patient representatives in such a process would add a valuable perspective and keep the ACO leaders in touch with those diverse perspectives.

Strategy Questions to be addressed early on by Leadership Team

  1. Loose PHO/IPA-style entity vs. Tight “Health System” entity?
  2. Emphasize business/administrative vs. clinical operations strengths in leadership selection?
  3. How do other disciplines such as IT, medical informatics, and epidemiology fit in?
  4. Leverage community pride in facilities vs. actively seek “virtual organization” plasticity?
  5. What geographic granularity?  Town, MSA, state, region, or national?
  6. What is role of non-geographically defined target markets / populations?  (Seniors?  Medicaid?  Families?  Concierge?  Retail? Complex cases?  Organ system focus? Medical tourists?)

Proactive Leadership Team Development

An essential process during the formative stages of an ACO is to carefully assess the expertise and capabilities of the various players that are leaders or candidates for leadership roles.  The idea is to identify strengths of the overall leadership team as well as to identify necessary capabilities and perspectives that are not present among the leadership team.  For example, a leadership team may include people with strong administrative skills and others with strong clinical management skills, but may lack people that can bridge between the two groups.  Or, there may be gaps in terms of specific areas of expertise such as analytics, medical informatics, health plan contract negotiations, etc.

This assessment process may also include work to map the viewpoints of the players regarding a number of key issues, so as to identify early on potential areas of conflict and set aside time focused on building consensus in those areas.

Reward Health Sciences may be helpful to your organization to facilitate such an assessment process in a way that is respectful and that offers insight to the leadership team.

More information about approaches to the structure and governance of ACOs is available here.

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