Lessons Learned: Insights from the trailblazers of accountable care
Health care in the United State is progressing toward an accountable care tipping point. CMS and Medicare have made significant progress in changing their payment structure from fee-for-service to “fee-for-value.” Plus, commercial payer/provider fee-for-value ventures have grown organically: patient-centered medical homes, episodic and bundled payments, shared savings/shared risk and accountable care organizations.
These accountable care models place varying degrees of clinical and financial risk on providers, and provide shared savings. Payment models are risk- and quality-adjusted, and providers have tools to help them manage risk that they didn’t have during the capitation phase of the 1990s.
Some successful fee-for-service practices have seen how unsustainable the payment model is and want to shape their own fate. One such organization is Cornerstone Healthcare of High Point, N.C. The large multi-specialty practice has been certified as a level 3 patient centered medical home and they have set up gain-sharing contracts with most of their payers. They anticipate being fully migrated to fee-for-value by 2017.
Monarch Healthcare achieved great success as an independent practice association covering nearly 200,000 people in Orange County, Calif. Their success working with independent physicians to keep patients healthy and manage utilization within their IPA model makes them an intriguing case study in making fee-for-value work.
This paper highlights a few fee-for-value trailblazers and shares some of the lessons they and others have learned that more organizations can emulate. The following clinical guidelines focus on changing care patterns:
Implement a team-based approach to care and measure
results
Train physicians and care teams to focus on population management rather than episodic care
Create a governance structure to ensure clinical protocols
are followed
“Productize” your delivery system