Physicians Leading Accountable Care

By Eugene Lindsey, MD, president and CEO, Atrius Health and Harvard Vanguard Medical Associates

The Accountable Care Organization (ACO) is where I find optimism in healthcare today. Far from being the flavor-of-the-week, there are successful ACOs across the countries providing sustainable, high quality patient centered care.

While there’s no one-size-fits-all blueprint for an ACO (nor should there be), the goals are the same: transforming health care to deliver the highest quality care possible. I am convinced that for this transformation to be successful, it must fundamentally be physician-led. Physicians working with patient care teams — e.g., nurse practitioners, behaviorists, nutritionists, population managers, administrative staff, and others — know best the current system and its inherent waste and are therefore suited best to led the operational and cultural change that bends the cost curve while improving patient health.

First and foremost, we recognized that for real cultural transformation to happen, it could not be only a management initiative; physicians have to embrace and lead the change from the ground up.

That’s why we are working to adopt the Toyota Lean operating platform that is built on respect for the people who are doing the work. With this as a cornerstone, we have begun to reorganize our practices around value creation for our patients by focusing on decentralized leadership and localized innovation that eliminates wastes. In addition to the benefits of higher care quality and efficiency, the Lean process of continual improvement has helped clinicians free up time to use for increased access for patients, including by phone and through the patient portal.

We have also established the Leadership Academy for chiefs and clinical leaders — a 10-month, MBA-style program focusing on leadership, management, financial stewardship and clinical operations — to accelerate the professional development and managerial skills essential to a successful, decentralized organization. So far more than 300 clinical leaders and administrators have participated in the program.

The results are real. Atrius Health reduced the cost of care delivery for 2010 as measured against prior trends by approximately $62 million through improving quality performance across all measures. It’s a testament to what’s possible when physicians have the support and resources to direct patient care according to their clinical judgment and established best practices.

We have known for years that the key to high-quality care is empowering the physician, but we weren’t the first. In 1933, a presidential committee charged with finding a way to address the rapidly increasing growth of health care expenditures (then 4 percent of GDP) concluded: “Medical service should be more largely furnished by groups of physicians and related practitioners, so organized as to maintain high standards of care, and to retain the personal relationship between patients and physicians.”

Nearly 80 years later, to paraphrase T. S. Eliot, we find ourselves where we started and know that place for the first time. Now, finally, is the time for physicians to take the lead with ACOs.

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