ACOs: Are PHOs in the Ascendancy? And If So, Where Does I.T. Fit In?

Dec. 28, 2013
A recent report by the Healthcare Intelligence Network, based on a survey of leaders of accountable care organizations, finds physician-hospital organizations increasingly leading ACO development. The implications for healthcare IT are important.

According to a recent report published by the Healthcare Intelligence Network,the number of accountable care organizations (ACOs) led by physician-hospital organizations (PHOs) nearly doubled over the last year, based on HIN’s third annual ACO survey. As of late 2013, the survey found, nearly one in three ACOs is now PHO-led.

What’s more, the composition of care delivery models within ACOs is also shifting, based on the survey’s results, with the number of ACOs with hospices more than doubling, from 19 percent to 42 percent, over the 12 months since the previous survey, and with long-term care and home health components also growing among ACOs.

Further, ACOs are growing larger, with 39 percent now encompassing between 5,000 and 9,999 lives, versus 24 percent citing that size a year ago. In addition, about 62 percent of ACOs offer a patient portal for their members.

Responses to the survey, conducted online in August, encompassed 138 organizations, with 22 percent of respondents representing hospitals or health systems, 15 percent consultants, 8 percent multispecialty physician groups, 8 percent PHOs, 7 percent primary care providers, and 24 percent categorizing their organizations as “other.”

So, should these results be surprising? For anyone who’s been around for more than ten years, really, not so much. PHOs first emerged in the late 1980s and early 1990s, as hospitals and physicians began to come together around managed care contracting. Now, as the accountable care movement evolves forward, the fact of renewed physician-hospital collaboration seems obvious and inevitable.

Yet beneath the surface, there remain many issues, including business issues (around contracting, and inevitably, of course, money issues), regulatory issues, technology issues, and physician and healthcare culture issues. On the one hand, both hospital leaders and physicians are perhaps more sober about the prospects for hospital ownership of physician practices, and even for general physician-hospital collaboration, than they were ten to 15 years ago.

So a lot has changed since PHOs first came into existence, and both the policy and business landscapes are different now. With healthcare reform-driven mandates, reimbursement cuts, and healthcare consolidation (on the hospital, physician group, and health plan sides alike) all current realities, the overall landscape for PHOs is vastly different from during the 1990s. And what else is different, vastly different, is this: the health information technology and data landscape. Indeed, one of the reasons (among many, frankly) that capitation was mostly a failure 15-20 years ago was the inability to provide practicing physicians with the kinds of performance dashboards that are proliferating everywhere these days, as well as the data warehouses and analytics solutions now widely available, to analyze performance across organizations and enterprises.

What all this means, at a very basic level, is that IT will be an absolute linchpin in the new ACO landscape. Indeed, without the strategic deployment of healthcare IT, the strategies of the newly structured, sometimes-PHO-guided, ACOs will falter on the same old rocks as did the strategies of the previous generation of coordinated-care vehicles.

On the other hand, with the right combination of strategic alignments and exquisitely deployed technologies, things really could take off in a new way this time around. So the results of this recent survey are worth noting, and worth pondering, with regard to the opportunities that healthcare and healthcare IT leaders have going forward in this still-emerging, rapidly evolving, space.

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