10 Things You Need to Know to Succeed and Be Happy in an ACO

Leigh Page

Disclosures

July 28, 2015

In This Article

8. ACOs Raise the Stature of PCPs

The ACO can be an uplifting experience for PCPs. Having long felt marginalized in the healthcare hierarchy, PCPs are situated at the hub of medical care in an ACO.

For instance, although PCPs don't have the gate-keeping role they have in HMOs—where they hold the purse strings and decide on referrals—in ACOs they're still expected to coordinate services and provide disease management, and have been dubbed "primary care managers."

"Under the ACO, the role of the PCP is going to change," says Dr Habis. "The PCP is going to have more influence and play a leadership role."

In that role, PCPs will need to keep a strict eye on what specialists do, because the ACO could be penalized financially if specialists order too many tests. PCPs also need to make sure specialists get test results promptly, so that they don't order the same tests again.

In an ACO, PCPs are also encouraged to become what's known as 'patient-centered medical homes.' Dr Dera says his own practice has been recognized as a level III medical home by the National Committee for Quality Assurance (NCQA). NewHealth helps him in this role by providing care management and a 24-hour, nurse-staffed call center, he says.

The BJC HealthCare ACO in St Louis also endorses medical homes. Dr Pogue says all BJC-employed PCPs have achieved NCQA level III recognition or are in the process of getting it. "This provides the beginnings of the primary care redesign process that's necessary for the ACO to change our daily workflows to care for our patients differently," he says.

How attractive is the star role that PCPs play in building solid ACOs? In a 2013 survey,[8] 61% of PCPs said they'd be willing to join an ACO—a higher rate than that of almost all specialties, including surgeons, radiologists, and emergency physicians.

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