Of all the challenges hospitals face in forming accountable care organizations, choosing compatible physicians and promoting care coordination are among the most formidable. The challenges are both technological and human in nature. Participating physicians need to be compatible, as they must collaborate to deliver efficient and effective care.

Methods used to form ACOs may not take advantage of existing practice patterns and relationships. The complexities of ACOs call for an approach that considers practice efficiency and effectiveness.

Hospitals in some communities can tap into aligned physicians and existing provider groups to form an ACO, while others will try to bring independent physicians together for the first time. A better approach is to assess the existing relationships among physicians in a community, especially primary care providers. One innovative tool to provide insight into these relationships is called social network analysis.

Social Network Analysis

At its most basic level, social network analysis is mapping and measuring relationships between and among people. Social networks play a fundamental role in the spread of information, ideas and influence among members.

Because social networks have a major effect on human behavior in a variety of populations and settings, it is no surprise that they influence physician behavior. Physicians form social networks in communities based on practice affiliations, referral patterns, managed care, friendships and more. Social network mapping identifies key aspects of network structure, such as the number of connections for each physician, location within clusters and centrality within networks. Network maps allow hospitals to identify physicians by degree of influence within their communities; they also identify the physicians who are influenced by other physicians.

Using Social Networks to Create Successful ACOs

Before forming ACOs, hospital leaders should inventory their physicians to determine if they have an adequate number of generalists and access to specialists. They can use social network maps to determine practice patterns and physician clusters — pre-existing relationships that can lead to more cohesive and more successful ACOs.

ACOs recognize the importance of primary care physicians in a coordinated, patient-centric health care system. Because primary care providers refer to specialty and hospital care, social network mapping can highlight the specialists and the hospitals with which they have existing relationships, as well as highlight parties who don't know each other well. These relationships can factor into the hospital-physician alignment strategy, enhancing the development of the partnership and yielding improved coordinated care with specialists and hospitals.

Successful ACOs also call for clinical guidelines. By using social relationships to disseminate information and encourage various behaviors, ACOs can promote guidelines and evidence-based medicine.

Implementing programs based on social influence is superior to blanket or undifferentiated approaches because social influence identifies thought and action leaders, and recognizes existing practice patterns and informal affiliation patterns. This leads to the "multiplier effect": Influence propagates through networks, leading to more rapid and more complete acceptance of practice behaviors.

The Benefits of Understanding Social Networks

By studying social networks, hospitals can identify influence patterns and develop strategies for creating ACOs in the following ways:

Choosing providers: ACOs that are created according to existing social networks will be more efficient than those created according to arbitrary, geographic or other criteria.

Facilitating information flow: Hospitals can use physician networks to spread information efficiently and effectively as well as distribute evidence-based best practices.

Promoting sustainability after forming ACOs: Using social network analytics can enhance long-term maintenance of informational and behavioral programs.

ACOs call for a strong alignment between hospitals and physicians. A tool such as social network analysis provides a unique lens to view organically formed physician relationships. With this insight, hospitals can develop a proactive approach to evaluating physicians and their natural relationships, ensuring successful ACOs.

Larry Miller, M.D., is the CEO of MedNetworks Inc., in Newton, Mass.