Are ACOs putting form ahead of function?

At UC Berkeley in the 70s, the secretary in the Department of Psychology pasted a bumper sticker on her desk positing the question: “… yes, but are we asking the right questions?”

For some reason, this subtle invitation remains with me today, echoing amidst the ACO fervor of “… better care at lower costs.”

… the good news is we’re making great time, the bad news is we don’t know where we are going. — Eastern Airlines Pilot

As is often the case, and perhaps so today, when you need to “do something” (since movement in the absence of same, seems like progress), but are not quite clear what that “something” looks like, there’s a tendency to default to the familiar, i.e., this is how we roll. The more conservative among us will hedge that risk by choosing “advisors” with conventional standing when considering what that something is.

In healthcare that more often than not, begins the lawyers and accountants, and generally starts with legal vehicle and organizational structure matters. While “mission, vision and values” are a part of that conversation, they generally do not lead the process by which the engagement unfolds.

Invariably, one or more savvy (entrepreneurial) physicians step forward to claim the “organization, governance and equity” card (OG&E), and off we go on structure of the entity vs. the more open ended, and perhaps, even chaotic but culture enabling, process of engaging physicians in the emotional, philosophical and “sweat equity” journey of infusing a ‘patient’s first’ culture into the new, or re-purposed, entity’s mission.

The temptation to put form ahead of function is a real, and a distinct warning sign. Any “check the box” deliverable schedule that does not have the “buy-in” of those (primarily independent physicians) who will determine whether proforma assumptions materialize, is fantasy.

It is not necessary to change. Survival is not mandatory. — W. Edwards Deming

The behavioral sciences tell us that if you are not part of the decision process, the odds are that you are less likely to honor any decisions made on your behalf. So, “trust the force Luke.” Go the extra mile and engage in the discomfort of process, and avoid the top down tendency of command and control execution, against an unreasonable timeline.

Gregg A. Masters is founder of ACO Watch.

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