ACO governance and organization models must build in accountability for providing integrated, high quality care—at a lower cost

This post is the first of an 11-part series that proposes structures and actions that characterize successful accountable care organizations.

There are currently between 25 million and 31 million people receiving care through Accountable Care Organizations. ACOs are among efforts underway to improve the way the health system serves people, with a strong focus on improving quality, reducing costs and increasing patient satisfaction.

While ACOs are a relatively new model for patient care delivery and community health management, some best Cynthia Kilroypractices are emerging with regard to managing complex relationships among stakeholders. For example, a governance structure that involves all partners, and fosters financial and clinical accountability will lead to long-term stability and success. To get there, it’s key to establish and define key roles, including an executive leadership team, an operational leadership team, a project management team and a physician leadership team.

The executive leadership team is responsible for managing the venture’s overall direction. If the ACO is made up of separate organizations, leadership from both the payer and provider organization is required to ensure collaboration and alignment of goals and decision-making. If the ACO is a single-provider organization, leadership should be composed of executives across organizational functions. Regardless of the ACO make-up, the executive team serves to define the guiding principles that align the partners to deliver on the defined clinical and financial goals.

The operational leadership team is comprised of senior-level leaders who have the authority and accountability to make and implement changes to day-today operations. These operational changes can include clinical, financial and support functions, including population management, network management and technology, but do not include changes to the provider clinical practice.

The physician leadership team, reporting directly to operational leadership, consists of key community physicians who act as evangelists to all physicians and clinicians for the partnership while fostering future success. The team should consist of PCPs, specialists and hospitalists who work in different settings and practices, offering a comprehensive perspective of the care delivery system’s opportunities and challenges.

It is critical that members of all leadership teams share the same vision of making health care more affordable, incentivizing quality rather than quantity and changing the care delivery model. A cohesive and consistent message among the partners’ leaders establishes and emphasizes the importance of the partnership’s mission and vision.

Part two of this series will discuss the key functions of the operations team.

–Cynthia Kilroy


6 thoughts on “ACO governance and organization models must build in accountability for providing integrated, high quality care—at a lower cost

  1. This is a really interesting article and has a reflection into the role played by community commissioning groups and some of the emerging thinking on whole systems care in the UK, albeit the role is that of strategic planners and market shapers, rather than direct providers. As a model for new ways of working, we have much to learn from one another

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