Phoenix rolls out accountable care network to improve pediatric care quality
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.