“We’re in a competitive market, but being in the Midwest we take a collegial and conservative approach with these relationships and the comanagement served us well. ... We wanted to make sure it was right for our system and the physicians,” says Garavet.
“The hospital-physician relationship has to be established efficiently and it has to be very measurable, especially in terms of outcomes. All our outcomes have a quantifiable ROI,”
When goals and objectives are spelled out, clinical comanagement agreements can create a strong alignment between the hospital and the group. So strong in fact, that in some cases they lead to a full acquisition, which was the case for Aspirus Heart and Vascular Institute. After renewing the contract with the group practice each year for the past three years, at the beginning of 2011 the group practice and hospital decided to make the relationship permanent through an acquisition.
As accountable care organizations call for a shift from an activity-based payment model to the bundled or risk- and outcomes-based one, patient satisfaction coupled with quality and outcome metrics need to be core components of these agreements.
“I think under an ACO with a bundled payment system the mechanism used to incentivize the physicians for alignment will be interesting to define,” says Garavet.
Katsianis feels as though the ACO is in many ways a tweaked version of managed care. “I spent 10 years in managed care, and I feel like ACOs are ‘capitation light’ … the difference between this and managed care is they won’t take the payment back,” says Katsianis.
Although hospitals, health systems, and physicians won’t fully know how these agreements will be affected until ACOs and bundled payments take full effect, Katsianis, Jack, and Garavet all agree they will be working on adding more quantifiable measures to these agreements in the coming years.