“Most physicians recognize that there’s plenty of waste and areas where resources are utilized inefficiently and, at times, ineffectively. We want to find ways to capitalize on these limited resources to improve efficiency and improve care. This is attractive to clinicians,” continues Dr. Dwyer.
Commercial ACOs
While much of the debate—and some outright hostility—has been directed towards the government plans, some of this attention may be misdirected. Regardless of what happens with the CMS models, the larger question concerns adoption of the ACO model by nongovernmental organizations.
“What is most important for rheumatologists,” says Dr. Hochman, “is what the commercial insurers are doing with ACOs.” Dr. Golbus agrees, and he assumes that the driving force behind ACOs will eventually be the commercial insurance programs. “We should embrace a broader definition, because we know we must improve quality and be more efficient,” to stay in play with commercial ACOs, explains Dr. Golbus. Currently, commercial ACOs are partnering with healthcare systems around the country. For example, Advocate Healthcare in Chicago has partnered with Blue Cross/Blue Shield of Illinois; Catholic Healthcare West is working with the California Public Employees’ Retirement System (CalPERS), Blue Shield, and Hill Physicians; and Norton Healthcare in Louisville, Ky., is partnering with Humana. ACOs can be hospital based or physician based. While much flexibility is possible, most ACOs are built on health systems.
Do Rheumatologists Fit In?
“Rheumatologists must demonstrate their value. How is seeing a rheumatologist cost effective?” asks Dr. Skea. He explains that in an ACO, the primary care physician will act as the quarterback, justifying decisions like referrals to specialists. Using the example of hip replacement in patients with rheumatoid arthritis, he says it’s time for rheumatologists to ask themselves how they can demonstrate that costlier downstream outcomes can be avoided by the management that they can provide up front. These are exactly the questions that ACOs will be asking before contracting with rheumatologists.
Dr. Skea says that to become involved in ACOs and remain valuable members, rheumatologists will need to demonstrate the value of their own services in specific, concrete ways. “The role of rheumatologists is changing. Change is an opportunity. Redefine your role in the planning and coordination of care and adding value. Moving to evidence-based medicine is critical and essential.”
“It’s competitive,” adds Dr. Skea. “Primary-care physicians will be the gatekeepers, so establishing relationships with them is important. A grassroots movement is probably necessary among rheumatologists.” He adds that given the type of medicine that rheumatologists practice, not everyone knows when and how to best use these specialists. “Decision makers need an education on the value they can provide,” he says.
