ACO leaders are going to need to acquire a new set of competencies. Recently I attended a conference in Boston on access, innovation and Accountable Care Organizations. I was scheduled to be on a panel at the end of the day talking about ACOs with a physician from Steward Health, who was standing in for their CEO and David Cutler, the economist from Harvard who helped construct Chapter 224 and advised the Obama administration on the theory and structure of the ACA. In the middle of the day I was scheduled to attend the Advisory meeting for the Health Policy Commission and was eager to be involved in those interesting discussions since I believe that Massachusetts has moved from being a leader in ACO thinking to becoming a reluctant observer of what is happening elsewhere, especially in the area of commercial ACO development. There are now tens of millions of Americans in almost 700 ACOs across the country.
I once read that futurists are not people who imagine things that do not yet exist; rather they are people who recognize that there are little bits of the future all around. A futurist is someone who can imagine how those little bits of future are expanding to a dominant scale. As I have said before, it was not long ago that ACOs were like unicorns. They were something everyone had heard about but that no one had ever seen. The opportunity for that joke is over. Now there are so many different varieties of ACOs that we should employ a biologist to help us with their classification by the environment they occupy, what they eat, what makes them work, and what the path of their future evolution might be. My questions include, Why are there so many varieties of ACOs? What do they have in common? And which ones are transitional forms that won’t survive?
I am interested in how ACOs vary now depending on such factors as their local medical economy, regional insurance industry, culture of their patients, and all the dimensions of location from urban to rural, red state to blue, physician group versus hospital system, middle America versus the Coasts versus the South and Southwest. What works for ACO leaders in the more rural environments of Maine or Vermont may not be exactly what we will find will work in Boston, Chicago, or Seattle. I would like to think that there will be more similarities than differences between the ACOs and that from the diversity we see now clarity will emerge about how to make them all more effective.
I would anticipate that ACO leaders will share a need for similar competencies and assets no matter how the details are configured. Data skills, actuarial tools, population management experience, process management and continuous improvement, systems engineering, and collaboration competency will all be important and now is the time to learn or acquire these skills through personal and organizational investment. Competency number one everywhere will be focused, committed leadership.
