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ACOs know that reducing costs is the key goal for Value-Based reimbursement. But strategies on how—or even whether—to engage physicians in that goal have not always been successful, to the detriment of all involved.
Part of the problem is that provider revenues still stem from Fee-for-Service payments. Physicians are still rewarded based on meeting volume of patients and revenues. Even if participating in an ACO, your physicians get very clear messages about meeting volume and revenue targets. Hospital and health system-based practices survive by ensuring that volume is maintained—especially in these times.
As health plan capitation and new Value-based risk payment models emerge, however, you should reassess your strategy for involving physicians. If your history involves using administrative tactics like coordination of care and population health as your main cost control strategies, you are curtailing opportunities to address the central cost drivers: decisions made by physicians (diagnostic or treatment choices) and patients (health and treatment choices). Don’t avoid that terrain if you plan for success under Risk.