April/May 2013

In the 1990s, it was easy to be a success. You had to work hard not to be a success. That’s not true any more,” according to Michael P. Recht, MD, Louis Marx professor of radiology at New York University School of Medicine and chair of the radiology department at NYU Langone Medical Center (New York, New York).

The ACO, a relatively new concept that met with great skepticism when it appeared in the Patient Protection and Affordable Care Act, now ranks at the top of the conversation-starter list in the radiology community. Imaging providers have debated whether it is necessary for them to engage with these entities, and, if they do, what roles they would play. The current consensus not only is that radiology cannot afford to ignore the ACO model, but also that a strategic approach must be followed if providers are to assume their positions successfully under the ACO umbrella.

Although radiology has employed clinical analytics for more than a decade, the field is in its infancy. Nonetheless, the possibilities are tantalizing—if technological, economic, political, and interoperability hurdles can be cleared.

Three factors distinguish big data from the analytics that many executive leaders are familiar with: volume, velocity, and variety. In a recent article that appeared in Harvard Business Review, McAfee and Brynjolfsson1 make the distinction and open a window on how two companies are harnessing big data to make more accurate predictions, better decisions, and more precise interventions—on an accelerated timetable.

For at least a dozen years, radiology has played a cat-and-mouse game with the notion of assuming a more active role in determining which patients get imaging. Due to concerns about referring physicians, the mouse, to date, remains elusive. The ascent of value creation in health care, however, has radiology not just thinking about a gatekeeping role, but preparing to assume one.

With the rapid changes in health care, radiology (like other specialties) has had to adapt to survive. Smaller practices have been acquired or consolidated with larger practices. This allows greater emphasis on efficiency, shared risk, and economies of scale. There is also a perceived sense of security that comes with the size of the organization. Larger organizations, in addition, have greater negotiating power with both providers and insurers. These practices have the ability to attract top-level management and administrative talent as well.