Phoenix rolls out accountable care net­work to im­prove pe­di­atric care qual­ity

Modern Healthcare - - COMMENT - By Robert Meyer In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed? View guide­lines at modernhealth­care.com/op-ed. Send drafts to As­sis­tant Man­ag­ing Edi­tor David May at dmay@modernhealth­care.com.

The greater Phoenix metropoli­tan area is home to some of the na­tion’s most dy­namic and in­no­va­tive health­care sys­tems.

In pe­di­atrics, Phoenix Chil­dren’s Hos­pi­tal is lead­ing the way in safety and trans­parency stan­dards. We are con­duct­ing re­search and clin­i­cal tri­als that are push­ing the fron­tiers of knowl­edge on dis­ease and treat­ment. And we are un­lock­ing the keys to hered­i­tary medicine through ge­nomic anal­y­sis.

As the stew­ard of the metro area’s only free-stand­ing chil­dren’s hos­pi­tal, my charge is to har­ness this trans­for­ma­tive en­ergy in health­care and drive the qual­ity of pe­di­atric care to its high­est lev­els for pa­tients and their fam­i­lies.

Of the many ways those stan­dards are achieved, one ap­proach that will have a ma­jor im­pact is in­te­grat­ing the prin­ci­ples of accountable care or­ga­ni­za­tions into pe­di­atric medicine. The ACO frame­work has taken on an ev­er­larger role in the health­care sphere in terms of cost man­age­ment and high­qual­ity care de­liv­ery, but un­til re­cently, ACO con­structs have largely gone un­tapped at chil­dren’s hos­pi­tals.

ACOs, from their devel­op­ment of qual­ity met­rics to the or­ga­ni­za­tion’s legal struc­ture, have been built with the adult pa­tient in mind. While many goals, such as co­or­di­nat­ing care, im­prov­ing qual­ity and con­tain­ing costs, are core com­po­nents of both adult and pe­di­atric net­works, accountable care is rel­a­tively new in pe­di­atrics.

Cer­tainly, ev­ery­one has been closely watch­ing the per­for­mance of ACOs in adult care from an out­comes per­spec­tive, but we re­al­ized early on that care co­or­di­na­tion works in the pe­di­atric realm as well. Over the past 24 months, Phoenix Chil­dren’s has rolled out a cus­tom­ized, clin­i­cally in­te­grated or­ga­ni­za­tion, the Phoenix Chil­dren’s Care Net­work.

The or­ga­ni­za­tion is an in­ter­con­nected sys­tem of in­de­pen­dent and hos­pi­tal­based providers work­ing col­lab­o­ra­tively to de­liver the best pos­si­ble out­comes, while also man­ag­ing the ris­ing cost of that care. The PCCN now boasts more than 800 providers, rep­re­sent­ing ap­prox­i­mately half of all gen­eral pe­di­a­tri­cians in the re­gion and the vast ma­jor­ity of pe­di­atric sub­spe­cial­ists. The model in­te­grates and re­wards physi­cian mem­bers around a com­mon com­mit­ment to qual­ity mea­sures, based on sci­en­tific ev­i­dence and cost im­prove­ment.

A clin­i­cally in­te­grated or­ga­ni­za­tion has in­her­ent dis­tinc­tions from an ACO. An ACO in­volves a vol­un­tary as­sem­bling of doc­tors, hos­pi­tals and other health­care providers, who pro­vide co­or­di­nated high-qual­ity care, typ­i­cally to Medi­care pa­tients. When an ACO suc­ceeds both in de­liv­er­ing ex­cep­tional care and spend­ing health­care dol­lars more wisely, it shares in the sav­ings it achieves. While an ACO’s con­tract­ing ca­pa­bil­ity is limited to a sole prod­uct— Medi­care—clin­i­cally in­te­grated or­ga­ni­za­tions op­er­ate in the Medi­care, Med­i­caid and com­mer­cial en­vi­ron­ments. They can of­fer a wealth of clin­i­cal ser­vices for chil­dren and adults.

While there is a sense of com­pe­ti­tion be­tween hos­pi­tals and in­de­pen­dent providers in a mar­ket, our net­work has come to­gether to cre­ate syn­er­gies in ac­cess and de­liv­ery. Across the net­work, th­ese physi­cians are com­mit­ted to im­prov­ing clin­i­cal per­for­mance in pri­mary care and more than 70 sub­spe­cial­ties of pe­di­atric care. Op­er­a­tional benefits of the clin­i­cally inte- grated or­ga­ni­za­tion in­clude im­proved com­mu­ni­ca­tion across par­tic­i­pat­ing physi­cians; health de­ci­sions made by the physi­cians and their pa­tients, not a payer; and physi­cian-de­fined stan­dards of care. Also, fi­nan­cial benefits in­clude min­i­mal cap­i­tal in­vest­ment to par­tic­i­pate; im­proved re­im­burse­ment rates linked to clin­i­cal out­comes/per­for­mance; and the abil­ity to con­tract jointly with pay­ers for de­fined ser­vices and prod­ucts.

The crux of our clin­i­cally in­te­grated or­ga­ni­za­tion is a fo­cus on value-based con­tract­ing rather than the tra­di­tional fee-for-ser­vice model. Re­im­burse­ment is based in part on achiev­ing pe­di­atric qual­ity mea­sures, in­cen­tiviz­ing the goals of im­proved care and cost ef­fi­cien­cies. Adult ACOs have only re­cently be­gun to re­lease re­sults in cost ef­fi­ciency and qual­ity; the ACO model, while cer­tainly not per­fect, is work­ing. We ex­pect the same strong out­comes will un­fold through our net­work.

To that end, the PCCN has been charged with defin­ing clin­i­cally sig­nif­i­cant met­rics by which physi­cian mem­bers and the net­work will be mea­sured. There are 14 ini­tial pri­mary-care mea­sures for net­work physi­cians al­ready ap­proved, and 34 mea­sures iden­ti­fied to eval­u­ate per­for­mance of our spe­cialty physi­cians.

Phoenix Chil­dren’s Care Net­work and or­ga­ni­za­tions like it are pi­o­neer­ing pe­di­atric-ded­i­cated clin­i­cally in­te­grated or­ga­ni­za­tions, build­ing in­fra­struc­tures that can serve as mod­els for other net­works across the coun­try. With health­care chang­ing at such a rapid pace, the task of pro­vid­ing the best value propo­si­tion for our pa­tients is a con­stant chal­lenge. Health­care lead­ers, whether they are serv­ing adult or pe­di­atric pop­u­la­tions, must up­grade their tool­kits so they can re­spond adroitly to achieve suc­cess­ful pa­tient-cen­tric sys­tems of care.

Robert Meyer is pres­i­dent and CEO of Phoenix Chil­dren’s Hos­pi­tal.

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