ACO Governance

The Chicken and the Pig and the ACO


I recently heard it said that while it takes both a chicken and a pig to make a ham and egg breakfast, the chicken is merely involved while the pig is fully committed.

How different is this from the relationship between hospital administrators on the one hand, and physicians on the other, in connection with the development of an ACO or another vehicle to bind physicians to the hospital?

Hospital administrators are merely involved in the process. They are in the chicken position. CEO tenure is often short and CEOs don’t tend to have owner or entrepreneur mentalities; they are managers – they will create an alignment structure, then get their raise, and then move on before the chickens come home to roost.

But for the physicians involved – involved in ACO structures, involved in acquisition of their practices or employment by the hospital – you’re being asked to fully commit: That’s the pig into ham position.

Not to stretch this story too far, but it’s entirely possible, actually more than probable, that the administrators will, to use the colloquial expression, lay an egg in respect of the ACO: in the long run it will fail, but those administrators will be long gone, moving on to other “success”. But you’ll be there, cooked.

So why is it that those merely involved are being allowed to shape the destiny of those who are being asked to fully commit?

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