Making the Case for ACOs
by Kim Ribbink | June 17, 2011
Improving the delivery of health care, while seeking the outcomes of accountable care organizations (ACOs), requires some fairly significant changes in how health care providers function. Even before ACOs are officially established, many hospitals, physicians and payers are becoming advocates for the types of changes ACOs will require. These supporters welcome a shift away from the fee-for-service, silo-type activities that have prevailed within the industry for so long.
To gain insight into how hospitals, physicians and payers are working to advance health care outcomes, Ignite spoke with two proponents of collaboration and enhanced coordination of care: Stephen Rosenthal, president and CEO of CMO, The Care Management Company of Montefiore Medical Center, and Justin Chang, MD, chief of emergency services at Kaiser Permanente, Colorado, and medical director of the Exempla St. Joseph Hospital Emergency Department. Together, they make the case for a new model.
Ignite: What needs to change in the way health care is delivered to achieve the dual ACO goals of better outcomes and reduced costs?
Rosenthal: Health care is often fragmented, with practitioners paid on a fee-for-service basis and everyone trying to maximize their silo. Health care reform seeks to move away from silos to focus on the continuum of care. We view that continuum as much broader than just what happens during the medical experience.
Chang: One, you have to have a wide variety of care providers willing to work together toward a common goal of better outcomes for patients. Two, you have to have the support networks behind all these providers, meaning chronic care coordinators, case management, nursing, even dietary. Electronic medical records are key to efficiency so all these individuals can share information regarding patients in real time.
Ignite: How do you define partnership in the context of the ACO model?
Rosenthal: Our partners are the other health systems and major insurance companies in our region, and we hope to collaborate to create a regional approach to managing the health of the population we service. We are looking to work with two other major hospital systems in the Bronx, N.Y. We will also participate with community health centers, known as federally qualified health centers in our region, which are where the population enters the system, as well as nursing homes, mental health community-based organizations and so on.
Chang: Kaiser Permanente has established a large, multi-specialty group that is salaried, as opposed to being paid on a fee-for-service basis, and is aligned around organizational objectives. The physicians in our group utilize the same electronic medical records; we order the same items in the same way; and this helps the network monitor groups for outcomes.
Ignite: What approaches are you taking to manage your partnerships or the way you coordinate care?
Rosenthal: We are connected to a health information exchange, which helps us understand what services patients get in different facilities. The more we know about the patient’s health care experience, the more effective we can be in providing that patient the right service at the right time and, perhaps, at the right cost.
Chang: It’s about having physicians in key locations partnering with each other and using the same electronic records, with support personnel who oversee the patient’s overall health and manage the transitions. That’s the beauty of an integrated ACO, because it’s during the transitions that most medical errors, readmissions, dropped medications and wrong information occur.
Ignite: What further steps need to be taken to create a more collaborative environment to improve health outcomes?
Rosenthal: Transparency is important so health care practitioners can compare their performance to their peers. Full public health awareness can change outcomes on a population level. If your community has a high level of obesity, you can have a much more significant impact if you’re talking to the community as a whole, providing education and awareness about health hazards. On the clinical side, we must start to insist on a clear methodology for using and monitoring best practices in clinical guidelines and dealing with gaps in care.
Chang: Systems, policies, procedures and protocols must be patient-centric, not physician-, hospital- or insurance-centric. That’s my litmus test.