7 Ways to Improve Accountability for Care

One consequence of the Patient Protection and Affordable Care Act is that it has shown a spotlight on what's missing in the current business model of healthcare: accountability — for coordination of care, for outcome measures that are more demanding and meaningful, for evidence-based, cost-effective decision making at all levels. In short, accountability for better care at lower cost.

The release of CMS's rules on accountable care organizations has dampened enthusiasm for the concept, but it should not distract industry leaders from several underlying truths: 1) the current healthcare model is not delivering value consistent with its cost; 2) current costs are unsustainable; and 3) accountable care is an important part of the solution, with or without an ACO structure.

Accountable care can be achieved through any care model that incentivizes providers to improve quality and efficiency of care. An ACO, as loosely defined in the legislation, is only one organizational construct which theoretically could help organizations increase accountability. It certainly is not the only approach to achieving the objective of better outcomes at lower cost.

Any provider can provide more accountable care
Nothing is (or ever has been) keeping any provider from creating more accountable care. Whether or not an ACO structure is an effective means to achieve this end is irrelevant. Rather than focus on restructuring, organizations should really be thinking about how to ensure they are providing accountability.

With or without an ACO, here's what it takes to provide more accountability:

1. Establish process metrics (e.g., costs by procedure, patient cycle time to key behavioral milestones). Use this data real time to manage cost and outcome variability and to identify opportunities to improve efficiency.

2. Establish quality and outcome metrics. Use this data to manage variability as well as to improve quality and outcomes.

3. Explore new reimbursement models. Traditional payment methods create little incentive to increase accountability, making improvements in cost and quality difficult. Alternatives, such as bundled pricing, have been introduced in an effort to create shared financial incentives that encourage providers to improve collaboration, integration and — as a result — accountability across the healthcare continuum.

4. Develop predictive care paths. Mapping out your process for delivering care is essential to promoting collaboration and accountability, managing variability and improving clinical practice across your organization.

5. Develop competencies and incentives that support increased accountability. Providing guidance in process improvement and change management can enable clinicians to be more effective in monitoring, evaluating and improving outcomes while controlling costs. Establishing performance expectations and incentive structures will encourage greater ownership.

6. Use evidence-based medicine. While achieving behavioral change can be difficult, incorporation of evidence-based practices can support the objective of achieving better outcomes at lower cost. Additionally, external research can serve as a benchmark for your organization's improvement efforts.

7. Take steps to facilitate provider coordination. Your organization should be a vehicle for effective, efficient and transparent provider collaboration. Developing the IT and system integration capabilities to implement a uniform EHR system will allow providers to communicate with each other seamlessly.

These steps are not easy to operationalize. They require an integrated effort and shared accountability between administrative and clinical leaders. They also require organizations to set cost and quality of care goals that go hand-in-hand. They cannot be segregated and addressed independently. All decisions in the care model have to be in the dual context of the economic and clinical value that would result. Accountable care is about improving this dual value proposition.

What are you waiting for?
As we've suggested, there isn't anything holding your organization back. There is, though, a rare market opportunity to seize the initiative and deliver more accountable care. Improving accountability will differentiate your organization in an increasingly competitive market in which cost and quality outcomes are growing more critical to success.  

Dana Hage, MPH, is a business analyst, and Eric Abrams, MBA., is a consultant at Numerof & Associates, Inc. NAI is a strategic management consulting firm focused on organizations in dynamic, rapidly changing industries.

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