Perspective: Operating Models Emerge for Accountable Care
This IDC Health Insights Perspective discusses the operating models for accountable care. As healthcare organizations have begun to take on financial risk and more actively manage patients, a number of operating models have emerged. The two primary models are either a centralized model, where all activities are typically carried out at the delivery system level, or a decentralized model, where all activity is conducted at the physician practice level. IDC Health Insights has found that organizations that use a combination of centralized and decentralized operations create a sustainable model for accountable care that is capable of managing the increasing level of risk. Organizations that take on a completely centralized approach to accountable care have invested or can invest in the infrastructure, domain expertise, and other resources required to manage programs, but they lack a relationship with the patient and are unable to intervene at the point of care to close gaps in care or review progress toward care plan goals. A decentralized approach has the benefit of a relationship with the patient and the ability to intervene at the point of care but often lacks the expertise, infrastructure, and financing required to scale a program.
Table 1 provides IDC Health Insights' suggested division of organizational dimensions between centralized and decentralized management. Keep in mind that not all organizations will fit this model. For example, a very large physician group practice may have the size and skill level to own all organizational dimensions. The designation of centralized model does not mean, for example, that physicians do not have access to data but that it is prepared and managed at the delivery system level. There is not a single dimension that does not require participation of both delivery system and physicians. During an interview for this research document, the COO of an integrated delivery system said, "transformation to risk-based contracting must be administratively led but physician driven."
The challenge for healthcare organizations is to find the balance between these two approaches that meets the culture and capabilities of all participating ecosystem members. While the model in Table 1 is a good place to start, organizations need to carefully evaluate the strengths of all parties and create clear expectations of roles and responsibilities. Sustainable accountable care requires an ecosystem where every participant should have a voice.Please Note: Extended description available upon request.