Despite health care’s steady march toward value
and its accompanying focus on population health,
many physicians remain disinterested and unengaged.
As technology continues to develop and value-based
programs grow increasingly complex and prevalent,
physicians are often the lost population in population
Risk-based contracts and pay-for-value are the
future of health care. Thousands of accountable care
organizations (ACOs), clinically integrated networks
(CINs), and other alternative payment models (APMs)
have been launched as tools to improve value and
reduce costs. The message is clear: Value-based care is
here to stay.
Garnering physician participation and endorsement remains an executive challenge and an industry
concern. Getting physicians to use solutions and accept
the quality metrics by which they will be measured is an
often overlooked common hurdle to overcome.
Based on the experiences of our 50-physician
primary care ACO with 100,0000 covered lives in
Goshen, Indiana, this article highlights five practical
strategies to build strong physician engagement and
partnerships for successful population health programs.
At Goshen Health System, 95% of physicians have
signed contracts to actively participate in the ACO and
its value-based initiatives.
At the Helm
The physician’s role in the success of an ACO and
its population health initiatives cannot be overlooked
or diminished. Although physicians may agree with the
ACO’s overarching goals of high-quality care and disease
prevention, relationships can become adversarial over
time. If physicians don’t have faith in the data they see,
they will not subscribe to the technology and methodology used to identify at-risk patients, manage care delivery
gaps, and take ownership in meeting the ACO’s goals.
Many believe engaging patients is the key to population health success. However, physician acceptance
and use of data determine how gaps in care and cost
reduction are affected. Therefore, physician engagement is an essential factor in determining the long-term
viability of an ACO.
According to an August 2016 report by the Centers
for Medicare & Medicaid Services (CMS) of Medicare
ACO results for 2015, 1 physician-led and integrated
(physician/hospital partnership) ACOs tended to do
better and were more likely to achieve shared savings
than larger ACOs or consolidated health systems.
Ranked by size, the smallest ACOs reported the highest
net savings per beneficiary. The data debunk the myth
that ACOs must be large or hospital-led to reduce
healthcare spending. Small, physician-led programs can
deliver impressive results.
To achieve its value-based goals, Goshen Health
continually focuses on lowering expenses and improving quality to receive shared savings incentives.
Admittedly, with ever-increasing demands on physician
time adding to the number of quality measures and
expectations of managing care, physician engagement
is difficult to sustain. Goshen Health’s ACO employs
five strategies to remain competitive, achieve quality
benchmarks, and manage total cost of care through
1. Give Physicians Reliable Data
Data reliability is the first hurdle in improving
population health and building successful physician
partnerships. Physicians are evaluated by quality metrics derived from clinical data; therefore, data must be
meaningful, accurate, and trustworthy.
In Goshen Health’s early days, physicians’ first
reaction to data was to reject it. Data validation was
paramount to securing physician confidence and establishing long-term support for the ACO’s population
health programs. An integrated platform was necessary
to paint a complete picture and provide validation from
the practice, provider, and individual patient.
For example, the ACO’s review of patients with
back pain revealed wide disparities in ordering patterns
across 50 primary care physicians. Some physicians
were ordering 10 times more back imaging tests than
others. Variations were also seen in the administration
of pneumonia vaccines and renal function screening for
patients on high-risk meds.
Because physicians felt or assumed they were
performing on par, they were reluctant to believe the
ACO’s data. Leadership went back and performed
manual chart reviews to validate findings. In most
cases, the data was correct. In some places, the physicians helped us find holes in the data that we could then
correct. This validation cycle is essential for every new
2. Build Comfort
Another hurdle that must be overcome with ACO
physicians is getting them comfortable relinquishing
ownership of payer contracts. This requires two “blank
The first is that they will participate in all contracts
signed by the ACO. Physicians must trust the ACO to
choose and secure mutually beneficial payer contracts