In 2012, St. Vincent's Medical Center in Bridgeport, Conn., launched a physician-hospital organization with regional physicians called St. Vincent's Health Partners.
The PHO essentially is a group of physicians and the hospital that work together to negotiate value-based contracts with payers and align care across the continuum. At the Becker's Hospital Review 5th Annual Meeting in Chicago on May 16, Thomas Raskauskas, MD, president and CEO of St. Vincent's Health Partners, explained how his group — which essentially is an accountable care organization — got to where it is today.
St. Vincent's includes the medical center, more than 370 physicians and mid-level providers and three skilled nursing facilities. It was the first organization in the nation to achieve URAC full accreditation for clinical integration, which it did this past March. Dr. Raskauskas said leaders created the organization so they could "monitor and control utilization of healthcare services that are designed to control costs and assure quality of care."
Providers interested in creating an ACO or similar type of accountable care structure must start by answering several questions, he said. For example, do you want to partner with Medicare or a commercial payer? This legal structure is of utmost importance, as Medicare is more stringent in its requirements while commercial partnerships allow for more liberties, Dr. Raskauskas said.
From there, providers must gain buy-in from their local physicians. They will be driving the entire operations; excluding them from the formation discussions would be a huge mistake. "Involve physicians early and often," Dr. Raskauskas said. "If you don't, you're doomed to fail."
Hospitals and physicians must also get several other ducks in a row, including outcomes tracking, data review, administrative functions like hiring the right personnel, determining budgets and setting up the right IT infrastructure.
More Articles on Becker's Hospital Review 5th Annual Meeting:
Some Hospitals Have Done "Population Health" For Years — They're Called Safety-Nets
Financial, Clinical Considerations When Bundling Payments
Using Data to Improve the Patient Experience