Lessons Learned: In­sights from the trail­blaz­ers of ac­count­able care

Modern Healthcare - - PERSPECTIVES -

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

Some suc­cess­ful fee-for-ser­vice prac­tices have seen how un­sus­tain­able the pay­ment model is and want to shape their own fate.

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