A/C/O: ‘Another Compromised Organization’ or ‘A Coordinated Orchestra?’

By Gregg A. Masters, MPH

Last Friday I moderated the HealthIT social media focused tweetchat tagged ‘#HITsm’, see context piece here, and transcript here. The theme centered on the value or centrality of HealthIT to ACO success. The conversation was lively (for additional context, ACO surprise provides metrics on dispersion and penetration into Medicare and commercial markets), and in part reflective of popular notions of whether these rapidly emerging ‘multicorns’ can succeed but more specifically served by social media.

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One tweet in particular caught my eye. While specific to a question on the role of social media to ACO development, it resonates with the bearish camp on ACOs in general (a view I challenge on a regular basis). I paused since the tweet was proffered by one of the brighter bulbs in the tool shed of EHR and HealthIT thought leadsership. It was in response to the following tweetchat question:

@HealthStandards #HITsm T5: Can social media ‘detect and amplify’ (preconfigure) preferred community referral interactions to grease the skids of an #ACO? Fri Nov 30 9:48:06 PST 2012

@ehrandhit Hard to see social media doing much to bring together ACOs. Within ACO’s social connections can really help though. #HITsm Fri Nov 30 9:52:28 PST 2012

I centered on this tweet as I engage with John Lynn (@techguy) in health reform and transformation exchanges now and then. In this case, I could not disagree more with his take. To wit the following exchange ensued:

@2healthguru really? Surprised to hear this especially from you!! #HITsm Fri Nov 30 9:52:40 PST 2012

@ehrandhit Not enough providers on it and discussing patient care. Maybe one day. Social principles, yes. Social media, no. #HITsm Fri Nov 30 9:55:44 PST 2012

@ACOwatch T5 I know of no other accelerator to connect like minded docs (i.e, culture) than #hcsm. A virtual ACO tribe preconfigured. #HITsm Fri Nov 30 9:55:49 PST 2012

I then wondered: what am I not seeing here? Is John correct by distinguishing between ‘social media principles, yes’ and ‘social media, no’? Does the low relative participation/utilization of social media limit it’s potential to inform ACO network development? Good questions! What are social media principles vs. the application of social media? Can they be separated? How? Why? How are we measuring physician involvement in social media?

If social media leverages the wisdom of the crowd, reveals, extends and informs conversations, enables collaboration or otherwise energizes social learning (both personal and professional), might the technology serve the interests of an ACO (a de-facto social network), or any series of structured activities designed to advance the triple aim? Intuitively I answer yes, but want to use this line of thinking to vet the reasoning process.

Finally, a broader sensitivity ties to the larger question of the value proposition of ACOs to enable the triple aim or build the sustainable healthcare ecosystem. So discerning the larger sentiment (bullish v. bearish) question might be whimsically framed in the search for wisdom by comedian/actor Steve Martin in the movie classic ‘the jerk’ wherein he was mentored in the less than nuanced discrimination of ‘sh*t from the shine-ola’.

This bearish attribution to ACOs, is a matter near and dear to my heart, since its camp includes some very smart people including the likes of Jeff Goldsmith, Regina Herzlinger, among some of the top in the pyramid of health-wonk thought leadership, while their suspect upside is more than offset by the likes of Elliott Fisher, Don Berwick, and more recently Don Crane to name a few.

Yet, the question remains amidst the market narrative, as most recently evidenced at Not Running a Hospital by Paul F Levy, in a blog post titled ‘Neither accountable nor caring nor organized’, which offers more thought fueling the bearish camp. (NOTE: A thank you to Dan Munro for the heads-up).

The net result” of ACOs, says Federal Trade Commissioner J. Thomas Rosch, “may therefore be higher costs and lower quality health care—precisely the opposite of its goal….

So back to the original question and the title of this blog post. Can social media connect like minded dots and pre-configure if you will an ACO? You betcha! Just look at its growing traction, and measure the social capital and utility created by connecting tweeps via this simple and corny to some medium. It is powerful, tribal, additive, collaborative, chaotic and democratic. Ideas surface and float on the basis of relevance and merit, not personalities nor politics.

From a gravity and use case point of view, applications are being demonstrated daily. For one measure, just look at the constantly expanding database of the healthcare hashtags project hosted by @Symplur. Take a measure of conferences, tweetchats and ‘regular’ hashtags added to their repository on a daily basis.

If the medium is the message, what we’re learning from the explosion of social media, is there are lots of voices/ideas looking for ways to make a difference. Some of those voices concern themselves with important healthcare considerations and need be collaboratively tapped and channeled in service of worthwhile societal needs. One of those consensus needs is the pursuit of the triple aim or creation of a patient centric, sustainable healthcare ecosystem. Why not use social media to reveal underlying referral patterns? Or to screen physicians for their values toward coordinated, seamless care? Or the willingness to be part of a team – the bottom line definition of an ACO?


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