One area in which physicians may need to make investments is in health information technology. Jonathan Blum, director of the Center for Medicare Management, said the ACO proposal is closely aligned with the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and the electronic health record incentive programs.
Coordinating the ACO quality measures with those in the EHR incentive programs reduces the burden on physicians and hospitals that are submitting data through the various programs, Mr. Blum said. It also offers the potential for physicians to offset some of their technology costs through the bonus payments they can earn by achieving meaningful use of their EHRs.
The move to ACOs will be a major shift, said Dr. Paul Grundy, director of health care transformation for IBM and president of the Patient-Centered Primary Care Collaborative. "You've got a $2.7 trillion stream going in the wrong direction," he said. "That's a huge river to overcome."
But despite the financial and cultural barriers that have prevented these types of shifts from occurring in the past, Dr. Grundy said the medical community is ready to make a change toward the patient-centered medical home concept and ACOs.
Many purchasers of health care, including Fortune 100 companies and the federal government, are already supporting the concept of the medical home and physicians who have made the switch love it, he said. "I think it's really clear that this is where we’re going and where we have to go."
The trend is being driven by more than just the provisions in the Affordable Care Act, he said. The escalating cost of health care is pushing businesses and other health care purchasers to look for alternatives to keep costs down.
At the same time, there are finally data to show how patients are being managed and what types of care are cost effective. Additionally, younger consumers want to access health care the same way they do their banking and shopping. "For them to be told by a practice that they can't access their laboratory data online, they'll just keep looking until they find someone who can," Dr. Grundy said.
Another player in the ACO field is the NCQA. The not-for-profit organization offers recognition programs for physicians, hospitals, and health plans in a number of areas. Starting this summer, the organization plans to unveil its standards for ACO accreditation. The first ACOs to go through the program could receive accreditation in 2012, according to Raena Grant Akin-Deko, assistant vice president for development at the NCQA.
The standards could be a "road map" for organizations to begin to build the capabilities to become an ACO, she said. "What we've done through these standards can help people understand what the important capabilities are and give them some direction about what are the things that they should be thinking about."
The NCQA recently concluded testing of its standards with 10 organizations that represent IPAs, multispecialty practice groups, and integrated delivery systems. One issue that came up during the testing is the importance of leadership within the ACO.
"We can define structural features that are important for [ACOs], but I think you cannot underestimate the importance of leadership and the cultural change toward patient centered care in forming these organizations," she said.
Alicia Ault and Naseem Miller contributed to this report.