Care Coordination in Accountable Care Organizations: Moving Beyond Structure and Incentives

Support tools—in particular, ones now made possible through new technology—can also enhance the efficiency and quality of collaboration.¹¹ For example, privacy-sensitive text messaging and e-mail allow clinicians to rapidly communicate with each other. In addition, electronic health records can allow them to easily identify patients with particular care coordination needs, such as diabetics overdue for ophthalmic exams. But high-tech support for care coordination could also be taken further through tools with social networking features. For instance, adding a “wiki” to a patient’s electronic medical record would enable physicians and other clinicians to maintain an updated history and comprehensive assessment in a single document (with links to more detailed data) and to share an integrated care plan.¹² Another potentially useful tool, particularly for medically complex patients, is activity streams. Fed by alerts on medication changes, transfers in care, physician appointments, and laboratory data, activity streams can be quickly scanned for relevant and important information, allowing clinicians to stay updated and connecting them with others participating in their patients’ care. Use of tools like these must be accompanied by training and evaluation in order to maximize their impact.

Organizational Culture. ACOs already have the “why” of their mission solidly defined: to provide high-quality, wellcoordinated care for their patients. Leaders within ACOs will need to take this mission and shape an organizational culture that supports the “how” for frontline clinicians. One way to signal the value of care coordination is by protecting time in the workday for care coordination activities and accounting for these demands in clinical scheduling. In addition, ACOs could formally schedule multi-disciplinary meetings to coordinate care for complex patients. Physicians and other healthcare providers should also be given a forum in which to share with each other innovative strategies for care coordination.

ACOs should consider including care coordination skills among the professional standards conveyed to current and prospective clinical staff. Just as good communication with patients is considered to be important, so too should good communication with other healthcare clinicians. Adding these skills to the definition of a high-quality provider and incorporating both patient and peer feedback on this metric into performance reviews will require a culture shift. But leaders of ACOs are uniquely positioned to spearhead this change because of the central role of care coordination in their mission.

CONCLUSIONS

There are many new ACOs and organizations similar to ACOs already working to provide coordinated care to patients. These groups will amass a wealth of experience and knowledge, and opportunities to share their best practices will be essential for continued improvement.¹³ A key component of such learning collaboratives should be the domains that we have outlined—training clinicians, providing support tools, and changing organizational culture—to help build the professional skills necessary for good care coordination. Making the development of these skills a priority will help ACOs live up to their potential to ameliorate the fragmentation and discontinuity that plague our healthcare system.

Acknowledgments
The authors wish to acknowledge Lawrence P. Casalino, MD, PhD (Weill Cornell Medical College), for comments on a draft of this article. They also wish to thank Peter B. Bach, MD (Memorial Sloan-Kettering Cancer Center), and Joseph B. Press, PhD (Deloitte Consulting), for conversations that informed the section on new technology.

Author Affiliations: From Departments of Public Health and Medicine (MJP), Weill Cornell Medical College, New York, NY; Weill Cornell Medical College (MDM), New York, NY; New York University Wagner Graduate School of Public Service (LHM), New York, NY.

Funding Source: None.

Author Disclosures: The authors (MJP, MDM, LHM) report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (MJP, MDM); acquisition of data (MJP, MDM, LHM); analysis and interpretation of data (MJP, MDM, LHM); drafting of the manuscript (MJP, MDM); critical revision of the manuscript for important intellectual content (MJP, MDM, LHM); administrative, technical, or logistic support (MJP); and supervision (MJP).

Address correspondence to: Matthew J. Press, MD, MSc, Department of Public Health, Weill Cornell Medical College, 402 E 67th St, New York, NY 10065. E-mail: map9069@med.cornell.edu.

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