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