And then Matthew Press and colleagues come along with this AJMC article on Care Coordination in Accountable Care Organizations: Moving Beyond Structure and Incentives.
Their message? You may have what's necessary, but it's not sufficient. Organization and incentives are not enough.
What's also needed are:
1. Training: physicians need education on coordination, collaboration communication and teamwork. The education should be an organizational priority and typically involve course work, observation and feedback with continuous evaluation. This cannot be accomplished in a one day workshop. An example of what it might take can be found here.
2. Support tools: since efficient information transfer must to be built into ACOs' workflows, informal "situation" or "personality" dependent communication between docs and nurses need to be transformed. An example of the kind of framework that Kaiser instituted can be found here. While you're at it, think about HIPAA-compliant texting, wiki-enabled EHR records and patient activity streams.
3. Culture: if front line staff are going to support the delivery of high quality and optimum cost care, the organization will need to protect time for care coordination activities, multi-disciplinary meetings, forums to share best practices and incentives that recognize collaborative behaviors.
Looks like the work has only just begun.
