We're now half-way through outlining our process for organizations to successfully re-architect their care delivery infrastructure to adopt new, value-based payment and care delivery models – such as ACOs. After the acquisition of data, aggregation of data and access to data by all stakeholders involved in patient care we come to our fourth (of six) A: adoption.

It is in our nature to be resistant to change. Every stakeholder in an ACO needs or wants access to data, but getting everyone to use ACO-related systems initially, and then on an on-going basis can be quite the challenge for many organizations. Adoption is about both an individual's technical prowess and about their emotional approach to it. It is aided by organizations making sure that data is accurate and easy to get and that clinicians understand the business goals of the ACO and how their use of the technology is in direct support of the goals. These factors are all very much intertwined. It can also be a 'chicken and egg' type of challenge as well, because if clinicians and care coordinators fail to adopt, key information will not be used for decision-making, making outcomes suffer. These effects may hinder the success and survival of an ACO.

The IT infrastructure elements that are essential to support ACO systems adoption are very similar to those that support the access to data (our previous A). These include EHR integration, personal health record (PHR), single sign on (SSO) and portal. Consulting support, ideally from clinicians with a deep knowledge of ambulatory and inpatient workflows and the economics of accountable care is also a key success factor for adoption. Understanding the right ways to make technology work for a range of stakeholders and to navigate the ever eventful change management requires specific skills and experience – so it would be wise for an organization to have a person with such knowledge on their side as they go through this process.

Once stakeholders are using the technology and data is being collected, we move on to the 5th A – a fundamental component for a successful ACO – analytics.