As an integrated delivery system, Aurora is well-positioned to meet those goals, says Patrick Falvey, senior vice president and chief integration officer. That means pulling together all of the pieces that make up the delivery system along the continuum of care, he says, from home health to pharmacies to physician practices to hospitals. And Aurora has begun crafting deals with ancillary providers to fill some of the gaps in the system, such as long-term care facilities.
Aurora will pursue the model whether or not ACOs come to fruition and even if healthcare reform is repealed, Falvey says. "If it does change, I think we're agile enough to [respond]," he says. "Whether it comes or not, this is a direction we've been moving in for years."
Like Aurora, the Rocky Mountain Hospital for Children in Denver (the pediatric arm of the 325-staffed-bed Presbyterian/St. Luke's Medical Center) is betting that its strategy will position it for success in the reform era marketplace. That strategy includes affiliations with community hospitals and a somewhat unusual philosophy that the hospital is not the center of the patient's universe.
Each of the six full-service hospitals in the Denver-based HealthONE Presbyterian/St. Luke's Medical Center health system went through a rigorous affiliation process that included an evaluation of clinical services, quality and outcomes, staffing, equipment, community relations, relationship with primary care providers, the scope of pediatric subspecialty services on site, and ED capabilities. The process was led by the chief medical officer to ensure that the review focused not only on administrative capabilities but also on clinical competencies.
Those hospitals that made it through the affiliation process must adhere to strict quality standards based on demonstrated best practices, contained in a 6-inch-thick binder. "We regularly assess that what we say we're doing is what we're actually accomplishing," says Rocky Mountain President and CEO Mimi Roberson. "You don't put the binder on the shelf."
Rocky Mountain coordinates care with its six affiliated community hospitals so that patients can be moved closer to home as soon as they are stable, allowing them to continue treatment closer to family and friends, improving patient satisfaction, and also strengthening ties with the affiliated community hospitals and referring physicians.
"We don't consider ourselves the home hospital," Roberson says. "The important thing for us to do is recognize that people choose their community hospitals because there's a level of trust there." The relationship between patient and primary care physician is similarly personal, she adds. That's why it is so important to return patients to their home hospitals and their primary care physicians as quickly as possible. "We support wholeheartedly them retaining their relationships."
Physicians should get used to this kind of collaboration and coordination of care, Wunker says. "Physicians need to drop the historical aversion to hierarchy and having others coordinate care. The train has left the station and the old model of Marcus Welby coordinating care may work in a handful of isolated communities but is not what payers, ACOs, and health systems are going to desire. The evidence is pretty clear that more coordination is needed," Wunker says.