5 Things No One Told Me Before I Launched an ACO
Larry B. Anderson, CEO of Tri-City Medical Center in Oceanside, Calif.: It would have been helpful in modeling our ACO to know the average Medicare spend per beneficiary, unique to our service area. This would have helped produce more accurate projections of potential savings and, therefore, allow for a more accurate presentation of the ACO concept to our participating physicians.
Work with providers you know and trust. Make sure the providers have significant experience in managing Medicare Advantage members, as the ACO concept and Medicare Advantage are very similar.
Kathryn Correia, CEO of HealthEast Care System in Minneapolis: Do not underestimate the need for communicating the changes to all of your stakeholders. I found the best way to communicate it was face-to-face — groups of medical leaders talking to small groups of physicians seemed to work well. We also used written communication and large group presentations.
Dan Doherty, Program Director of AdvocateCare, part of Advocate Health Care, in Oakbrook, Ill.: Moving from a fee-for-service to a value-based environment requires more than the development of new programs, it necessitates a significant shift in culture for leaders within the organization.
Scott Hines, Co-Chief Clinical Transformation Officer of Crystal Run Healthcare in Middletown, N.Y.: The biggest lesson that Crystal Run Healthcare ACO has learned to date is how integral claims level data is in helping to develop strategies to reduce cost and maintain quality. As a single entity ACO comprised solely of a physician owned, multispecialty group, we felt that we had a good sense as to what the biggest drivers of cost were based on our internal billing records. However, when we received our claims data we were surprised to learn the degree of leakage from Crystal Run Healthcare to other facilities, particularly for tertiary care, the frequency and cost of laboratory studies ordered not just internally, but externally and that the largest cost item to date is post-acute rehabilitation
Now that we know the magnitude of the cost involved, we are actively pursuing relationships with tertiary care centers and post-acute rehabilitation facilities that can prove to us that they can provide the highest level of quality to our patients for the lowest cost. As for the laboratory data, we have started the process of streamlining laboratory orders and focusing our variation reduction projects on standardizing what labs are really necessary to provide quality care for our most common chronic conditions.
As we receive more and more claims-level data from CMS, we are sure that it will lead to further discoveries on novel ways to improve the quality of care that we provide while simultaneously reducing cost. This is why Crystal Run Healthcare feels very strongly that all claims level data, from both commercial and government payers, needs to be available to providers. Only with such data on our entire patient population will we truly be able to provide "accountable care."
Simon Prince, MD, CEO of Beacon Health Partners in Manhasset, N.Y.: Look out for the vendors. Vendor interest is at a fever pitch and was underappreciated. The entrepreneurial spirit is alive and well with a seemingly endless supply of companies lined up for a piece of the ACO pie.
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