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In this guest post, Judy Rich, president and CEO of Tucson Medical Center, shares the innovative ways her teams are leveraging technology to support improvements in care transitions. Tucson Medical Center is also part of Arizona Connected Care, which was recently selected to participate in the Medicare Shared Savings Program (Shared Savings Program) Accountable Care Organization (ACO), sponsored by the Centers for Medicare and Medicaid Services (CMS).
Every hospital executive and clinician today is working to effectively manage what we call the “white space” – the place where patients exist between episodes of care, after a doctor’s appointment, surgery or procedure and before their next touch point or follow up. While it’s challenging to connect with patients once they leave the hospital and are out of our control, doing so is critical to both increasing quality of care and controlling healthcare costs. Mastering the “white space” plays a key role in helping patients stay on the road to recovery and ultimately reduce hospital readmissions.
In 2011, the health care industry went through some interesting changes – from Meaningful Use attestations and delays to ICD-10 – but one of the less publicized milestones was one that may have a deeper and longer lasting effect on how we care for patients and that was the CMS final rule on the Medicare Shared Savings Program (MSSP). I believe that this rule, and the types of new provider risk-bearing models it encourages, will spawn a whole new generation of health information technology. A generation that focuses not just on patients currently seeing doctors and being admitted to hospitals and appearing on a census, but on a much broader spectrum of analytics, clinical transformation tools, wellness/prevention solutions and automated care management systems for comprehensive management of patient populations.
For an MSSP ACO to succeed, it must deliver care to its attributed Medicare fee-for-service population for less than it costs CMS. Comparing an ACO’s actual cost of care to CMS’ pre-determined value of what it is expected to cost them ─ or the ACO’s “hurdle rate” ─ determines if an MSSP ACO will be able to participate in gain. But as of now, CMS hasn’t released these hurdle rates ─ making it very difficult for an MSSP ACO to ascertain whether success is possible under these parameters, and therefore to decide with any confidence whether or not to proceed to contract with CMS.
I appreciated all the dialogue that my recent post on KevinMD’s blog, “The emergency department in an ACO world,” has generated over the past week or so – the number of comments is a great indicator that ED physicians are not just letting this topic go by. I’ve compiled the following post to address as many as I can:
In the era of accountable care, you’ll notice that many hospitals and health systems are already driving towards more collaborative workflow. The integrated delivery network (IDN) is changing significantly, and for the better. But in high-acuity care areas, like the emergency department (ED), the challenge of treating patients more holistically in what is already a fast-paced environment is concerning for physicians evaluating the pay-for-performance model.
Evaluating and managing population risk has traditionally been the payer’s role in the health care system. But as providers become increasingly accountable for populations, they will need to be equipped with many of the same competencies that payers have been relying on for years. This includes the right technology to capture both clinical and claims data, but also the ability to analyze and transform these data into actionable information that affords the delivery of high quality, efficient health care and ultimately real population health — that’s where actuarial services come in.
It’s been one busy week! As director of the newly launched Optum Institute for Sustainable Health, I’ve been presenting our first set of findings at the The World Congress 2nd Annual Leadership Summit on Accountable Care Organizations (ACOs) in San Diego, flying all over the country to meet with providers, and on the phone with health care reporters who’ve been interested in our study – everyone from HealthLeaders to Healthcare Finance News to USA Today. Who needs sleep, right??
Like many folks in the healthcare industry, the “light reading” that has graced my nightstand over this past week or two has consisted of 700 pages of the Department of Health and Human Services’ Final Rule on Medicare Accountable Care Organizations (ACOs). Overall, the changes from the draft proposal, aimed at nudging providers away from a fee-for-service model and into one of shared savings and risk, are both substantial and encouraging, with a number of key improvements in three key areas:
While many things remain undefined when it comes to the industry’s move to pay for performance, one thing is certain – one size does not fit all. Encouraged by the regulations around Medicare’s CMS-based ACO, providers, physicians and payers are teaming up in a variety of ways to create new models of collaborative care. Although the CMS-defined ACO model has the lowest downside and many health systems will need to adopt it due to competitive pressures, the following models allow for the ability to scale to various-sized populations and design customized shared savings arrangements tailored to the needs and demographics of each community:
With financial, clinical and regulatory pressures increasing steadily, and the new and confounding acronyms appearing daily, many hospitals and health systems today are wondering where they should first put their focus — building a robust Health Information Exchange (HIE), or preparing for an Accountable Care Organization (ACO) or other payment reform model?
Each variety of HIE — statewide, regional or private/IDN — has different goals. Privately held HIEs are rooted in the desire to achieve clinical and operational excellence among physicians within a health system, while regional or statewide systems are focused on sharing patient information across providers in a geographic area. We all know that trying to connect these disparate systems can be challenging, and that linking into a larger network requires additional infrastructure investment. But rather than implementing a less robust system that will need to be replaced in two years, the inevitability of some kind of payment reform and shared risk model coming to a town near you means that health care organizations need to invest in an HIE that both enables meaningful use now and has the power to support collaborative care models later.
