2. For big systems, loose confederations are out—true operating company structures are in.
Ascension owns one of the largest health systems in the country, but it has largely operated as a loose confederation of regional systems that have been free to find their own way in many respects—especially in clinical standardization.
As taking variation out of medical care becomes a more important contributor to value, the organization is taking a big risk by building out and rolling up modalities like post-acute care and home health. That takes huge investment, but dovetails into Ascension's larger strategy of "taking care of millions of lives from birth to death," according to Anthony Tersigni, the system's president and CEO.
He believes that standardization of clinical practice and other operational priorities are more difficult under a holding company model.
3. Hospitals and health systems must become more paternalistic toward patients.
Navigating healthcare can be complex for even the most educated individuals. Ellis Medicine President and CEO James Connolly says the most recognizable healthcare authority in a given region needs to take responsibilities that it hasn't in the past. For instance, in helping patients make thoughtful and efficient decisions with their healthcare.
In some ways, this means getting into areas of social services and social work that hospitals have traditionally not been involved in. Building these linkages, in Ellis's case, with more than 50 local agencies and partners, helps patients avoid readmission or expensive follow-up care that happens when their social needs are neglected.
It's a tough learning curve, but Connolly says it's necessary given value-based reimbursement that is coming on ever more strongly in both the commercial and government payer sectors. "What we built is equally applicable to Medicare, Medicaid or commercially insured people," he says. "The main thing we were developing was the ability to coordinate and manage care in the community. That's a cornerstone toward being an ACO."
Not that every hospital or health system should become an ACO, or even should become part of a larger one. That's a decision that can only be made based on the facts as you see them and on the details of the possible deal.
Accountability, by contrast, will not be optional.
Philip Betbeze is the senior leadership editor at HealthLeaders.