Accountable care organizations (ACOs), medical homes, coordinated care, and pay-for-performance. These were all prominent lingo during healthcare reform and are what many predict to be the crux of the current ongoing healthcare transformation. The focus and payments for these kinds of practices are aimed at primary care providers, however. So where does that leave the specialists of the world?
What role will specialists play in the “neighborhoods” surrounding medical homes and the periphery of ACOs? Here’s what you need to know to navigate the new and improved world of managed care.
Change is coming
Norman Kahn, MD, executive vice president and CEO of the Council of Medical Specialty Societies, said the National Committee for Quality Assurance has worked to create standards for specialists to become accredited as a medical home neighborhood provider. The standards are in draft form and should be published this spring. Dr. Kahn said the steps are essentially: tracking and coordinating referrals, providing access and communication, identifying and coordinating their patient population, planning and managing care, tracking and coordinating care, and measuring and improving performance.
You may think you are already performing a lot of these tasks, but moving from a traditional practice to an ACO or medical home setting will not be easy.
“It will feel like a burden in the beginning,” Kahn said. “If we are all honest, we would admit that care is not coordinated like it should be … there is a tremendous duplication of effort. Coordination of care isn’t efficient now but it will improve.”
One of the major things specialists have to consider is the new relationship they will have with primary care providers. Joe Stubbs, past president of the American College of Physicians, said the solution will be coordination.
“Better defining roles as a consultant to primary care and better communication of information back and forth will be the key path that will make ACOs or neighborhoods a success,” he said.
Part of that will be linking by electronic communication or just increasing phone communication. Another part is explicitly defining the roles of each provider, Stubbs said. The American College of Physicians and other groups are developing contracts around the different kinds of referrals that can occur. The organization has created referral templates that outline exactly what is expected from the consultant, be it an opinion, a procedure, or assumption of care in a medical home.