ACO consultants eager to help -- but do you need one?
■ Physicians may find themselves fielding inquiries from advisers claiming expertise on accountable care organizations. How do doctors figure out if they need outside advice?
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As accountable care organizations take root in pilot projects across the country, another wave of activity has surged around them: consulting. It's a phenomenon that has sparked a joking alternative definition for ACO: "any consultant's opportunity."
"This is a huge business opportunity, not just for us, but many others," said Todd Cozzens, CEO for accountable care solutions at Optum, a subsidiary of UnitedHealth Group, which put together an ACO consulting team in spring 2011. Cozzens estimated that the total value of the ACO marketplace is in the billions of dollars.
Physicians trying to make sure they don't miss out on their own opportunity may be overwhelmed with the number and variety of people offering to act as accountable care advisers.
Several types of organizations offer to help physicians, hospitals and health plans form ACOs:
- Consulting subsidiaries of large companies.
- Electronic medical record system vendors.
- Independent consultancies, large and small.
- Organized medical groups.
- Health information technology consortiums, chambers of commerce or other community entities.
"Everybody's got a bent on this," Cozzens said. "The EMR companies are saying, 'You can do this all with our systems and clinical data.'... The big box consulting firms have lots of strategic and governance expertise, but they don't have tools. Many of them come to us and say, 'We need you to design, build and operate the ACO.' "
Faced with so many choices, physicians first should assess whether they need to hire a consultant at all, said Justin Barnes, vice president at Atlanta health information technology company Greenway. He is co-chair of the Accountable Care Community of Practice, a group of health IT companies that offers tools for accountable care and sharing best practices in the field.
Barnes said physicians who believe they can devote 5% to 10% of their time to investigating and developing a practice's accountable care options may not need to pay someone for that work.
"My first thought is not to have anybody sell you any services," he said. "No one can represent your practice like you can. As a leader of your practice, you also are going to have to lead the future of health care for your practice."
For the do-it-yourself physicians, free resources are available from the American Medical Association, Medical Group Management Assn. and other groups that can serve much the same purpose as a consultant, Barnes said.
If a physician isn't interested in spending time on investigating accountable care options, the best adviser depends on the practice and its goals, Barnes said. "There's no one vendor in America that's right for every single practice."
Jenny Wang, a San Francisco-based health care attorney with the law firm Paul Hastings, advised approaching consultants who know a lot about health care and aren't claiming to hold a magic ACO formula.
"First of all, it's so new, nobody really knows what it is," Wang said. "I'd be very wary of consultants, even attorneys, offering ACO 'expertise.' "
Instead, she said, physicians should seek out an adviser with expertise in a wide range of health care topics, because the accountable care concept touches on so many aspects of health care, including tax codes and antitrust rules.
Because some of those rules and regulations will vary by state, Wang suggested working with someone who has done work in the same state as the medical practice.