Accountable Care

A year or so ago, there was a lot of discussion and doubt as to whether or not Accountable Care Organizations (ACOs) would ever become a reality.  CMS had put out their first draft on the proposed guidelines and comments were coming from all over the place.  Large organizations were commenting that they were going to take a “wait and see” position as the regulations seemed somewhat unworkable.  Everyone agreed that it was complex and financially risky, but so is healthcare delivery.  The government listened, modified their plans and it now seems as though ACOs are off and running.

Take a look at the piece in Modern Healthcare that talks about all the new ACOs recently approved and the huge number they anticipate applying next month for the 2013 enrollment period.  Note how many physicians and patients are involved today and then try to estimate next year’s numbers.  ACOs are a huge movement and although they were a part of the ACA, most experts would expect them to survive even if parts of the reform act are overturned.

CMS is rightfully proud that they were able to get this controversial and complex system up and running in record time.  Perhaps the reason it survived was that it was the right thing to do.  Who would be against more coordination in care, meaningful quality measures, evidenced based protocols and an ability for private providers to share in the government savings?  Perhaps the proof of the viability of the concept comes with the adoption of the ACO principles by so many commercial insurers.

So what does the ACO movement mean for the pharmaceutical world and how will it impact your day-to-day job?  Perhaps the first question to ask yourself is how much do you really know about the movement that is becoming so incredibly important to your customers?  There are a number of sources providing information and publications to help get you up to speed.  Take a look at Accountable Care News as a possible starting point and note their offer for a free comprehensive issue that covers the final guidelines.  The CMS website and their innovation section is also a solid reference.  Make sure to take a look at Dr. Berwick’s video.  The more you start digging in, the more interesting it will become.  Perhaps most important, is that you fully understand the role of pharmaceuticals in the financial models.

I like to talk about leapfrog opportunities.  This happens when there are big changes in the environment.  Those companies and individuals that are first to recognize the change, develop strategies and implement programs to take advantage of the new environment have the opportunity to leap over their competition.  It may be getting a little late for ACOs as there has been a lot discussion and activity over the last year, but perhaps there is still time to catch up and move more efficiently now that everything is clearer than it was just a few months ago.

As marketers, this is a time to aggressively learn and figure out what this means for you and your product.  Don’t wait until others in the organization, such as the managed market folks, tell you what ACOs are all about and what your company is going to do about them.  Take charge.  Learn for yourself.  Read the articles and listen to the webcasts.  Talk to your physician advisors.  Work closely with PCPs to see how it is unfolding from their perspective.  Become a leading authority in your company.  Keep track of the thought leaders in the area.  Volunteer to teach others in your company.  Hold a seminar for the department.  Build ACO strategies and tactics into your business plans.  Work with your legal experts to determine what can and can’t be done with ACOs.  Show leadership.  Help your company leap over your competition.

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