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ACOs & Staffing

By Dan White, President of Strategic Workforce Solutions, AMN Healthcare


Following the Supreme Court decision of King v. Burwell, healthcare reform is moving forward and with new models of care and payment, particularly Accountable Care Organizations, or ACOs, that will grow and expand. As this occurs, ACOs will require healthcare professionals with different skill sets and mindsets than those who practiced strictly under fee-for-service.


An ACO is a network of healthcare professionals and providers, usually hospitals and group practices, that share financial responsibility with payers. If an ACO can limit unnecessary spending while maintaining or improving the health of its patients, it receives a share of the savings. There are various formulas for the shared savings, including a recent federal rule that allows high levels of reward in exchange high levels of financial risk. Currently, there are about 750 ACO-type entities in existence.


The number and size of ACOs are expected to grow. One expert estimates that the number of people covered by ACOs could rise from 23.5 million today to 70 million in 2020 and 150 million by 2025.1 However, as this payment model is still very young, the structure of ACOs may change over the years.


Accountable care represents the leading edge in the movement from volume-based to value-based healthcare and from sole practitioners to team-based care. Since ACOs share in the savings for the group of patients they treat, ACO physicians, nurses and allied health professionals are heavily incentivized to keep their patients healthy and manage their care as efficiently as possible. At the same time, ACOs must achieve specific quality benchmarks to receive the shared savings. Working in multidisciplinary teams provides collective, holistic and integrated care for patients, which can result in greater efficiency and quality.


Primary care is central to ACOs. While this may be a single primary care practitioner, it’s likely to become a team that could include:


  • Physicians
  • Registered Nurses
  • Clinical Nurse Specialists
  • Nurse Practitioners
  • Physician Assistants
  • Pharmacists
  • Medical Assistants
  • Health Educators
  • Behavioralists
  • Social Workers

Since coordination of patient care and communication among team members is critical to provide high-quality care while containing costs, clinical roles in care management and health information technology are necessary for accountable care success. These jobs may include:


  • Care Coordinators
  • Clinical Coordinators
  • Case Managers
  • Healthcare Navigators
  • Health Coaches
  • Clinical Informaticists
  • Nursing Informaticists
  • Pharmacy Informaticists
  • Clinical Engineers – IT

Equally as important as skills are the characteristics of healthcare professionals suitable for ACOs. To begin, the physician’s role will evolve to where the physician is not seen as an individual contributor but as an organizational leader guiding the integrated care of the patient and the quality and financial success of the ACO. In addition, the need for nurse leadership will increase to support better management of the primary care needs of the whole patient.


Since ACOs involve patient-centered care, engaging the patient as an equal health partner needs to supplant a paternalistic approach. A commitment to good communications, both with the patient and among team members, is imperative. So are flexibility, adaptive skills and a collaborative spirit. Team members also must be confident participants in the Information Age. Effective use of information technology is vital to ACO success, so team members need to be completely comfortable with its use in the patient-care environment.


For healthcare professionals, ACOs represent a singular opportunity – though not a risk-free one — to practice at the leading edge of patient care through team-based, patient-centered models that focus on integrated, coordinated care supported by information technology. There is an incentive of enhanced compensation, particularly with new CMS rule that allows greater revenues in exchange for greater risks.


Working as part of an ACO requires the leading-edge skills needed in today’s era of healthcare transformation. But, it requires a certain mindset, too. Healthcare professionals who take part in ACOs must be willing to accept risk, either directly as a partner in a venture that may succeed or fail, or indirectly, as an employee involved in the venture. In personal traits, they must be adaptive and collaborative. And finally, they must be believers in the fundamental theory of ACOs — that success in quality improvement and cost containment are reciprocal.


1Growth and Dispersion of Accountable Care Organizations in 2015, HealthAffairs Blog, March 2015. David Muhlestein.


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