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The Bridge to Accountable Care Organizations

The Bridge to Accountable Care Organizations

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Published by Ignatius Bau

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Published by: Ignatius Bau on May 24, 2011
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A    C     O     A    C     O     
 In collaboration with
January 2011
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 Case Studies
 
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The Bridge to
 
 Accountable Care
Organizations
 
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©2011 HealthLeader Media, a diviin f HCPr, Inc.
HEAltHlEAdERS MEdiA BREAktHRougHS: the Bre  Accnabe Care oranzans
in collaboration with
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T Bdg to
in coordinating around a defined set of local hospitals,medical groups, and ancillary providers to close thegaps in care. The federal government is biting on theidea that ACOs fit part of a larger strategy of pushingMedicare costs down, so ACO pilots are included in thePatient Protection and Affordable Care Act.
T
he theory behind the push for healthcareaccountable care organizations (ACO) isbased on a simple truth: that most healthcareis still local. As Dartmouth’s Elliott Fisher and otherproponents of ACOs have long argued, the fastest wayto gains in cost and efficiency might be concentrated
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BY jIM MoLPus
 Accoutab Ca
 Analysis from HealthLeaders Media
 
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HEAltHlEAdERS MEdiA BREAktHRougHS: the Bre  Accnabe Care oranzans
in collaboration with
3
©2011 HealthLeader Media, a diviin f HCPr, Inc.
 
share
 Analysis
 
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the Bre  Accnabe Care oranzans
The idea f ACo ha me academic elegance t it, bt in prac-tical, hitrical, and trategic term, their creatin ha ped mreqetin than anwer. Many hpital and phyician are heitantt embrace the cncept, fearing a retrn t 1990-tyle integratinthat ended badly. other cite the relative lack f reglatry clarityarnd legal and antitrt trctre, and whether the financingmdel will cme t pprt the witch frm fee-fr-ervice back tglbal payment r me frm f hared aving.sme, hwever, ee mre clarity in the viin and are embracingACo a a new cntext t reinfrce change tward element f carethat are t better fr the patient. What frm an ACo take i per-hap le imprtant than beginning the dialge amng a crdinat-ed grp f prvider, payer, and ther partner t find new wayt redce wate and imprve care. Elli M. “Mac” Knight, enir vicepreident f amblatry ervice at Clmbia, sC–baed PalmettHealth, ay the idea f an ACo came arnd t a hi healthytem wa having eri lng-term trategic dicin abtclinical reengineering. s Palmett ha frmed an ACo amng itemplyed and allied phyician t eventally act a a cntractingentity with payer. Fr nw, the ACo i fcing n gaining regla-try apprval, bilding infratrctre capabilitie fr crdinatedcare, and defining a et f cre clinical gal. Nne f that wld behappening if health leader did nt believe ACo had the pwer tchange the ytem, ay Knight.“I trly believe that an ACo frm a trategic tandpint ha tbe a tranfrmative rganizatin,” Knight ay. “What we can’t ethe ACo fr i t imply drive imprved perfrmance f the ytema it crrently exit. The ACo ha t erve t tranfrm the rga-nizatin int a ttally different delivery mdel ver the next everalyear. If we dn’t d that, if we dn’t e it t achieve what I like tthink f a tw brad bective fr the ftre and the healthcareytem—imprving qality and driving efficiency—then there’really n prpe in ging thrgh all the trggle and pain.”
Bn he capabes
If ACo are t take rt, prvider mt ae and bild capabili-tie in pecific area f crdinated care, inclding patient-centeredmedical hme and pplatin health management. That necearilybeg fr neceary imprvement t the infratrctre, incldingadvancement f the electrnic medical recrd and data miningcapabilitie, a well a bilding the primary care bae f phyicianand enir-level primary care nre. Beynd the cre infratrc-tre qetin, hpital mt al ae and bild their capabili-tie t deliver hme-baed and ptacte care.Nancy Berner, MD, chief medical fficer fr orange Cnty,CA–baed Mnarch Healthcare, ne f the pilt ite fr aBrking/Dartmth ACo tdy, ay the challenge cme indefining which capabilitie t rebild given that there i n cttrctre t ffer RoI at thi pint.“Everyne agree there ha t be me aving that ge back tthe payer, which in thi cae i the gvernment, bt there al needt be engh fnding  that we can have peple wh are imple-menting thee ct-aving initiative like managing care, analyzingreadmiin, and getting t t the hme,” Berner ay. “The

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