There will be many process and technological changes coming with Accountable Care Organizations(ACOs), but the biggest challenge is change itself, according to Joel J. Reich, MD, FACEP, MMM, CPE, SVP for Medical Affairs/Chief Medical Officer, Eastern Connecticut Health Network (ECHN). “With clinical integration and ACOs, we are forming new business entities and connecting the clinical and business sides like we have never done before. This requires cooperation, decision-making and governance sharing on a difference scale,” he says.
A speaker at the National Healthcare CMO/CMIO Summit 2014, in Las Vegas, Nevada, March 6-7, Reich discusses what will change for the CMO and CMIO.
What organizational changes is the ACO model bringing about?
The biggest challenge is change itself. Organizations are moving from an environment where they were competing against each other to one where they will be sharing patients, money and measuring performance in new ways. How will power be shared? How will they all work together? Who will fund these organizations and infrastructures? Who will be equipped to lead these organizations?
What cultural transformation is required to make this model work? What do CMOs and CMIOs need to know?
First, there needs to be a clear vision of the business purpose and an understanding of the organizational goals. They cannot go in believing they have to do it, “because everyone else is doing it”. They must understand what is fundamentally driving change in the US healthcare system, at the political and economic level, and how it relates to their local situation.
Third, they must be able to sell the concept of pay for performance and risk assumption to physicians and be able to explain the impact on patients. You can form a new business entity with by-laws and dues, but buy-in from the people who will be operating within the system is crucial.
How must the different entities cooperate?
Starting at the top when the new organization is being formed, it is important to figure out how the governance board is made up. Whether it is a Medicare or a private ACO, there must be a business case and a significant number of physicians on the board for policy development and enforcement, decision-making, and quality management. Contractual and financial infrastructure has to be built, as well as Information Technology (IT) infrastructure.
Data from many disparate systems (insurance transaction and clinical) must be available in one place, in a system that can collect, analyze and display the data to manage care, measure performance, and enable business modeling.
How will this impact the CMO/CMIO role?
Traditional leadership roles are changing and new roles are emerging. CMOs are getting progressively more involved in clinical integration including IT. In some organizations CMIOs are leading the IT function, while in others they lead the clinical aspects of IT. Some report to the CIO but others to the CMO. The makeup of the rest of the executive group includes new roles such as Chief Transformation, Integration or Technology Officer.
For more information about the National Healthcare CMO/CMIO Summit 2014, visit http://www.nhcmiosummit.com/
