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Early Staffing Strategies for Accountable Care Catalyst Learning

Deploy a Dedicated Project Manager

The transition to ACO is transformational, and-- in the face of competing priorities, uncertainty and communication gaps-- daunting.  As a starting point, the Advisory Board Company, who recently shared a report on ACO Early Staffing Strategies at ASHHRA 2011, recommends deploying a dedicated Project Manager to guide the transition.  An effective ACO Project Manager must have project management and clinical experience.  Another key characteristic is comfort with ambiguity since much of the ACO journey covers uncharted territory. At AtlantiCare, a Baldrige recognized regional healthcare system located in southeast New Jersey, ACO Project Director Paige Younkin was appointed in October 2010.  Ms. Younkin, a nurse who specializes in critical care, initially joined the AtlaniCare team to help develop the organization’s open-heart surgery program.  From there, her role morphed into clinical development before she assumed her current title.  She stresses that for an ACO Manager to be effective, one must also have the ability to connect people who need to work together to achieve clinical integration. “A key part of my role is making the right connections.  At AtlantiCare, many parts of the system that previously did not work together now link to create a structure based on ACO law and its different components,” she says. For example, the organization now applies a system-wide approach to developing care models that connect the patient across the continuum.  The Case Manager title has shifted to Care Manager, and the role has been redesigned to allow more for a more “front and center” approach as opposed to working behind the scenes.  Specialized professionals like heart-failure coordinators have been responsible for developing care a model that extends beyond their function and applies more “big picture” thinking. “If one is looking at redesigning how care is delivered, then any employees who deal with disease issues and planning must look at things in a different way,” says Younkin. Younkin suggests that after appointing an ACO leader, organizations identify and study the population for which they will be accountable.  At AtlantiCare, the focus is on the local commercial market.  Based on that population, the organization is in the process of examining needs and analyzing internal infrastructure to identify quick wins, like changing internal employee benefit design to provide local employers with an example of how to lower costs and improve health outcomes. Considering the massive resources and knowledge needed to create an ACO, a temptation surely exists for some healthcare organizations to do nothing, hoping to be left alone. Choosing that approach could irreparably damage a hospital’s competitive edge, resulting in competitors pursuing an ACO and retaining (or attracting) more cases from current primary care physicians. “The ACO transition is transformational work that involves risk, but is necessary. The paradigm has shifted, and many practices that have been successful in the past may not be conducive to the same results in the future. ” Younkin says.

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