The 16 Core Competencies Your ACO Needs to Succeed

Here are the 16 ACO core competencies providers need to succeed under Value-Based Care.

 

Provider organizations need 16 core competencies to succeed under Value-Based Care. Some of these competencies can’t be developed by the provider organization alone. They require a payer organization as a strategic partner. Others may not be relevant for both Medicare and private markets. The private market allows more flexibility in ACO-payer arrangements, and it also requires more adaptability from the ACO.

 

Provider organizations are solely responsible for these nine competencies:

 

  • Developing the legal and organizational structure
  • Developing a physician-driven governance (board and committees) model
  • Identifying and nurturing physician leadership
  • Assembling, monitoring and policing the provider network
  • Developing a care model using evidence-based protocols to support population health management
  • Implementing disease management strategies for high-cost patients
  • Distributing financial incentives to participating providers
  • EHR connectivity and integration
  • Data collection, analytics and reporting

 

Provider organizations should engage their payer partner(s) in the decision-making process for these four competencies:

 

  • Driving desired behavior through benefits structure and plan design
  • Defining mutually acceptable value-based payment models that ensure appropriate levels of gain/ risk-sharing
  • Developing performance measures that support quality, efficiency and cost-saving objectives
  • Exchanging claims data in a timely fashion and usable format

 

The payer/partner is primarily responsible for these three competencies, until the provider network matures and gains experience:

 

  • Claims processing
  • Fee-for-service payments to network providers
  • Insurance sales and marketing