ACO Blueprints: Options in Accountability
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What do you want to accomplish with an ACO?
The basic tenet of an ACO is to create a delivery model with processes, financial incentives, and technology systems to deliver quality care in a cost-efficient way.
The best way to start, suggests Lehn, is to look for simple ways to add value to something you already do and then move forward from that. There's been growing concern at Banner Health about the increasing number of Arizona residents who either lack healthcare coverage or lack coverage that provides access to quality care. It's a bottom-line issue. Banner Health Network has teamed with Aetna, a diversified healthcare benefits company that serves 36.4 million people, to offer a shared-risk product, Aetna Whole Health, which covers coordinated care only at Banner Health's Arizona facilities. The incentive for employees is reduced cost of care. The ACO will base compensation and rewards on reduced hospital readmissions, expanded access to primary care physicians, and increased use of preventive screenings. The effort builds on the health system's extensive investment in electronic medical records and health IT.
The partners in the Northwest Metro Alliance, an ACO in Minneapolis, have focused on clinical care process changes and designs to improve quality and reduce costs for 27,000 at-risk members. A review of prescribing patterns helped increase the use of generic drugs and produced a $1 million savings. "We also looked at high-tech imaging to see when it really benefits the patient and where might it be overutilized without clear benefits," explains Penny Wheeler, MD, chief clinical officer at Allina Health Hospitals and Clinics, which collaborates on the alliance with Bloomington, Minn.–based HealthPartners.
What makes the collaboration unique is that the four-hospital HealthPartners and the 11-hospital Allina are competitors in Minneapolis market.
How should your ACO be organized?
The short answer to the question of ACO organization is: Any way you want it to be. While CMS-deemed Pioneer and MSSP ACOs must follow a prescribed set of organizational requirements and meet specific quality and cost-containment goals, commercial ACOs have more flexibility. Organizers of commercial ACOs are working their way through what they want their ACO to become and how they want to serve their markets. For some commercial ACOs, the triple aim is a loose concept, while others are developing specific strategies to meet those goals.
The National Committee for Quality Assurance is trying to establish some order to the ACO process through a three-tier accreditation program that will verify ACO competence. Crystal Run Healthcare is among the early adopters of the NCQA process. "The NCQA provides external validation … It says we'll achieve what we say we will," explains Teitelbaum.
Pointing to BHN's mix of commercial and Medicare projects, Lehn says he likes the freedom of different models of ACOs. "The free market, with different ideas and different markets, is really healthy for the industry. I hope we don't end up with monolithic models [of ACOs]. I hope this results in a lot of innovation and creativity."
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