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Why one prom­i­nent provider is em­brac­ing the change

Modern Healthcare - - FRONT PAGE - Mike Mur­phy Mike Mur­phy is pres­i­dent and CEO of Sharp Health­care, San Diego.

Sharp Health­care seeks to lead the way on ACOS

Much has been writ­ten and will con­tinue to be writ­ten about ac­count­able care or­ga­ni­za­tions, whether they are la­beled Pioneer, Shared Sav­ings or of­fered through com­mer­cial car­ri­ers. There are many re­spected health­care lead­ers who think that ACOS will bring great ben­e­fit to pa­tients and providers while bend­ing the cost curve. There are also a sim­i­lar num­ber of re­spected health­care lead­ers who are skep­ti­cal of such claims. The true im­pact of ACOS will play out over the next sev­eral years and be­yond.

The ACO con­cept gen­er­ally sug­gests that an or­ga­ni­za­tion of health­care providers (physi­cians, mid-level providers, hos­pi­tals, am­bu­la­tory surgery cen­ters and post-acute providers that de­liver the con­tin­uum of a pa­tient’s care) work to­gether in an or­ga­nized ap­proach and be held ac­count­able for the qual­ity, cost and over­all care for an as­signed pop­u­la­tion of pa­tients. All providers in­volved in a pa­tient’s com­plete con­tin­uum of care will be con­nected elec­tron­i­cally and have ac­cess to and share the as­signed pa­tient’s med­i­cal in­for­ma­tion. Based on the data and in­di­vid­ual pa­tient needs, providers will en­gage this pop­u­la­tion, co­or­di­nat­ing and man­ag­ing each pa­tient’s care to not only pro­vide bet­ter care, but to do so in a more cost-ef­fec­tive man­ner.

This con­cept is be­ing ex­plored (Jan. 2, p. 10) be­cause the or­ga­ni­za­tions and en­ti­ties that are pay­ing the bills (Medi­care, Med­i­caid, em­ploy­ers, com­mer­cial in­sur­ers, etc.) see the cur­rent model as not fi­nan­cially sus­tain­able. In ad­di­tion to the cost con­cerns, these or­ga­ni­za­tions and en­ti­ties, and the pa­tients they rep­re­sent, also are clear that the health­care sys­tem should be pro­duc­ing bet­ter qual­ity out­comes for the pa­tients and pop­u­la­tions served.

Sharp Health­care is a fully in­te­grated health­care de­liv­ery sys­tem in San Diego. We have four acute-care hos­pi­tals, three spe­cialty hos­pi­tals, two af­fil­i­ated med­i­cal groups, a full spec­trum of post-acute ser­vices (in­clud­ing skilled-nurs­ing, home health and hospice) and our own health plan. We pro­vide more than 28% of the in­pa­tient ad­mis­sions and a sim­i­lar makeup of the am­bu­la­tory-care pro­vided in the San Diego mar­ket­place.

De­spite the many un­knowns around the ACO con­cept, con­sis­tent with Sharp Health­Care’s his­tory, we are com­mit­ted to the ex­plo­ration and de­vel­op­ment of in­no­va­tive pay­ment mod­els that are aimed at de­liv­er­ing co­or­di­nated, pa­tient-cen­tered care that sets

We be­lieve providers should be lead­ers in defin­ing so­lu­tions

to the cur­rent health­care pay­ment and de­liv­ery mod­els

com­mu­nity stan­dards, ex­ceeds pa­tient ex­pec­ta­tions and are pro­vided in a con­ve­nient, cost­ef­fec­tive and ac­ces­si­ble man­ner.

We have a record of ac­cept­ing dif­fer­ent pay­ment mod­els, hav­ing taken fully del­e­gated risk for pa­tient pop­u­la­tions since 1985 (in­clud­ing more than 280,000 pa­tients for which we re­ceive a pop­u­la­tion-based pay­ment to­day), and have worked with pay­ers and our health plan in the de­vel­op­ment of nar­row net­works, tiered prod­ucts and other ar­range­ments that we think bet­ter align pay­ment and de­liv­ery. We be­lieve providers should be lead­ers in defin­ing the so­lu­tions to the cur­rent mod­els. To­gether with our af­fil­i­ated physi­cians and the peo­ple of Sharp Health­care, we want to be part of the so­lu­tion, and we be­lieve we can make a dif­fer­ence.

We are proud to have been se­lected as a Pioneer ACO and look for­ward to ac­tively en­gag­ing with our 32,000 aligned ben­e­fi­cia­ries in a man­ner that will im­prove their health and en­hance their out­comes. In ad­di­tion to our Pioneer ACO, our af­fil­i­ated med­i­cal groups have also en­tered into ACO agree­ments with two com­mer­cial car­ri­ers cov­er­ing ap­prox­i­mately 21,000 at­trib­uted ben­e­fi­cia­ries.

We see these ACO mod­els as a ve­hi­cle to ex­pand our sig­nif­i­cant ex­ist­ing man­aged-care in­fra­struc­ture and ex­pe­ri­ence to pa­tients who have not been en­gaged with their providers along the en­tire con­tin­uum of care. We are con­fi­dent that uti­liz­ing data an­a­lyt­ics that in­clude the com­plete spec­trum of a pa­tient’s med­i­cal his­tory, and con­nect­ing our providers with this in­for­ma­tion, will yield pos­i­tive re­sults through a com­pre­hen­sive and co­or­di­nated ap­proach that best meets pa­tient and provider needs, re­sult­ing in higher qual­ity and a more cost-ef­fec­tive out­come.

That’s not to say the ACO jour­ney will be an easy one. Even within our es­tab­lished in­te­grated health­care de­liv­ery sys­tem, we have sig­nif­i­cant in­vest­ments and im­prove­ments to be made in the ar­eas of care man­age­ment, in­for­mat­ics, pa­tient en­gage­ment and tran­si­tions of care along the con­tin­uum to name just a few. These im­prove­ments will not only make us bet­ter for our ACO pop­u­la­tions, but will make us a bet­ter or­ga­ni­za­tion for ev­ery pa­tient we see. As providers be­gin to im­ple­ment ACOS, we are sure there will be or­ga­ni­za­tions that will do it well and help us all de­fine a bet­ter model for the fu­ture. We also are sure that there will be or­ga­ni­za­tions that will strug­gle and not have great suc­cess, and we will learn great lessons from them also.

Sharp has long be­lieved that an in­te­grated, co­or­di­nated ap­proach across the full spec­trum of care re­sults in bet­ter qual­ity out­comes, pro­vides pa­tients and their fam­i­lies with bet­ter ex­pe­ri­ences and is more cost-ef­fec­tive. We are look­ing for­ward to the ex­plo­ration and in­no­va­tion that will oc­cur at Sharp around the ACO ap­proach. We are con­fi­dent that our ef­forts will re­sult in great lessons for us and oth­ers, and we know that through this process we will all im­prove.

The Pioneer ACO is nei­ther a boon­dog­gle nor a panacea; it is a part of a jour­ney to a sys­tem that pro­duces bet­ter care for in­di­vid­u­als, bet­ter health for pop­u­la­tions and re­duces the his­tor­i­cal health­care cost trend. And this is a jour­ney we must all em­brace.

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