When a Clinic Leaves Your ACO, the Signs Were Already There
Clinics almost never leave an ACO over one thing. They drift. Nearly every warning sign along the way gets read as a relationship problem when it's really a workload problem.
The termination notice usually arrives as a surprise in the fourth quarter. Then someone goes back through the file, and the signs are all there.
The meeting attendance tapered off in March. The portal logins stopped in June. There were two emails in August about payment timing that got answered and closed. None of it looked like an exit at the time. All of it does now.
I hosted a webinar last year with Shaun Romero, President and COO of ClearPath Family Healthcare, on why clinics join ACOs and why they leave. The most useful thing he said was that clinics almost never leave over one thing. They drift. By the time a clinic is comparing your ACO to another one, the decision has mostly been made. What’s left is confirmation.
Most conversations about clinic retention stop there. What gets skipped is what’s underneath the drift. Nearly every early warning sign looks like a relationship problem when it’s really a workload problem. That changes what you do about it, and it’s the difference between a retention program that works and one that just generates meetings.
The six signals, and what’s usually behind them.
Take the six signs we see most often. There’s how each one gets interpreted, and there’s what’s usually driving it.
Attendance at ACO events drops. Interpreted as “the clinic is disengaging.” In practice, it’s workload. The meeting is competing with charting that has to happen anyway, and charting wins.
Portal logins fall off. Interpreted as “they’ve lost interest.” In practice, it’s workload. The portal is asking them to do something they’ve already done elsewhere.
They start questioning the value proposition. Interpreted as “they’re unhappy.” In practice, it’s workload. The value is real, but administrative overhead consumes it before it reaches the clinic.
They build their own analytics or care coordination function. Interpreted as “they’re preparing to leave.” In practice, it’s workload. They built it because they needed something, and waiting was more expensive than building.
New leadership arrives and priorities shift. Interpreted as “the new person doesn’t believe in value-based care.” In practice, it’s workload. The new person inherited the administrative load without inheriting the history that once justified it.
They ask about exit processes and data portability. Interpreted as “they’re halfway out.” In practice, it’s workload. They’re pricing the burden against the return, which is a thing a competent operator does periodically whether or not they intend to leave.
Five of those six get reported upward as engagement problems. Almost all of them are workload problems that got filed under the wrong heading.
Engagement programs only treat the symptom
The standard response to drift is outreach. More check-ins. Flexible meeting formats. Recorded sessions and office hours. Celebrating clinic wins in the newsletter. Tailoring communication to what each clinic cares about.
All of that is worth doing. It’s in our checklist, and it helps. But every item on that list adds something to the clinic’s calendar. The response to “this clinic is carrying more than it can hold” cannot be “let’s schedule more time with them.” That’s not a retention strategy. It’s a politeness strategy, and it buys you a quarter.
The only source that knows what was actually done is the clinic’s own documentation. That’s the one behind the hardest door.
The burden is specific, and it’s mostly reconciliation
Administrative load gets discussed in the abstract. Up close it’s a short list of repetitive work:
- Logging into multiple payer and ACO portals to pull care gap lists and discharge summaries
- Building outreach lists by hand from attribution files that arrive monthly
- Opening charts one at a time to find evidence a gap was already closed, because the report doesn’t know
- Completing attestations after a visit for decisions the provider already made during it
- Re-typing the same information into several different portals
Most of that doesn’t require a clinician. It requires an administrative person, and the clinic has to hire one. Every new payer contract adds another portal, another attribution file, another set of attestations, so the cost of staying in your ACO quietly becomes a headcount question.
That’s the load that shows up, eighteen months later, as a clinic that’s “disengaged.”
The part that isn’t in the checklist
After the webinar, our team at Smartlink built a checklist of the six signs, with questions to ask and actions to take for each. It’s worth using.
But I don’t want to hand it over without saying what it leaves out. The checklist implies the hard part is noticing. For most ACO leaders it isn’t — they can name the clinic that’s drifting right now, and have been able to for months.
The hard part is that noticing gives you two options. You can spend more of the clinic’s time convincing them the relationship is worth it. Or you can take work off their desk and let the relationship make its own case.
Clinics don’t leave ACOs because nobody noticed. They leave because noticing, by itself, doesn’t take any work off their desk.
