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

Matthew J. Press, MD, MSc; Marilyn D. Michelow, MD; and Lucy H. MacPhail, PhD
In order to live up to their potential, ACOs should ensure that clinical staff possess the professional skills necessary to effectively coordinate care.
Accountable care organizations (ACOs) are considered by many to be a key component of healthcare delivery system improvement. One expectation is that the structural elements of the ACO model, including clinical integration and financial accountability, will lead to better coordination of care for patients. But, while structure and incentives may facilitate the delivery of coordinated care, they will not necessarily ensure that care coordination is done well. For that, physicians and other healthcare providers within ACOs must possess and utilize specific skills, particularly in the areas of collaboration, communication, and teamwork. In this article, we present strategies in 3 domains—training, support tools, and organizational culture—that ACOs can implement to foster the development of these skills and support their use in clinical practice.


(Am J Manag Care. 2012;18(12):778-780)
While clinical integration and financial incentives should facilitate care coordination in accountable care organizations (ACOs), they will not necessarily ensure that care coordination is done well. In response, ACOs will have to develop and support professional skills, particularly in the areas of collaboration, communication, and teamwork. Strategies for ACOs to build these skills include:

  • Establish training programs designed to enhance clinicians’ care coordination skills.

  • Implement support tools that enable the use of these skills in clinical practice.

  •  Create an organizational culture that recognizes and values the use of these skills.

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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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