Molpus: Diana and Dave, you talked about the cost-benefit analysis not being there to justify participation in the Pioneer ACO. Are there other pilots and programs that do fit?
Hendel: We found that rather than going down the path of the Pioneer ACO, MemorialCare Health System would best be served in the long run by developing integration in a network of providers working closely with payers and employers. One current area of focus is the California Children Services. Reimbursement for 75% of our patients at Miller Children's Hospital is through CCS. Traditionally, that's been fee-for-service, a reimbursement model that has meant longer lengths of stay, more utilization, and less integration. The state and its eight designated children's hospitals came together to move toward a very different model, which is a much more capitated network. The pilot will be on a relatively small scale and involve children with chronic diseases that may last their entire lifespan. The data will allow us to evaluate the clinical and financial impact on that child as they move into adulthood. We're looking at that as both a study and a model that we can create to better integrate care while improving costs and outcomes.
Brooks: Remember, the structure of the formal ACO or the components of accountable care are all toward a macro basis. How do we innovate and how do we improve performance for our communities? How do we improve the safety of care? How do we improve the patient experience, and how do we lower overall cost for the community? That's what we're all hopefully trying to shoot for. The vehicles and tools are going to ebb and flow. For Medicare, we're using our own health plan. For the commercial side, we're working with the various health plans in the state. We've got medical home pilots. We have shared-risk approaches. For Medicaid, we're working with health plans specific to that population base. We've had a bundled-payment shared PHO with our medical staff for about 13 years specific to heart care.