ACOs: One System's Approach Toward Accountability and Success

One of the prominent aspects of the recent healthcare reform discussion is the effort to change the reimbursement methodology for both hospitals and physicians. A number of models, including the patient centered medical home, partial or full capitation or bundled payment structures have been proposed. Some of these have been around for more than a decade and others are now being piloted for the first time across the country.

One newer model, the Accountable Care Organization, is closely aligned with our vision at Guthrie for providing high quality integrated care. The purpose shared by all these models is to provide incentives (through reimbursement methods) to healthcare providers who are able to effectively and efficiently manage patient healthcare needs across the continuum of care.

One of the key differences in the ACO model is the design that requires providers — primary care physicians, specialists and hospitals — to be accountable for the health of a population of patients which they serve. Use of tools like electronic health records which give providers direct access to important patient health information, and foster an environment where best practices are shared and patient care is well coordinated, are all components of ACOs. Built into the ACO model is an incentive for the value of care, as opposed to the volume of care. This aspect of the ACO model is meant to further support the true coordination of care.

Not surprisingly, many experts predict that integrated health care organizations, like our own, will be most successful at implementing the ACO model. Organizations like Guthrie are very well positioned to meet the basic criteria of this model of care. One challenge that exists in all integrated delivery systems is developing an infrastructure for measuring and managing the progress of the greater organization against its' strategies and goals. Our practice of using the five-pillar framework (quality, service, people, finance and growth) to set goals at every level of the organization provides us with a consistent focus and a way to measure improvement year over year. The ability to align goals across the primary/specialty care and acute care settings provides us with a tool that encourages better collaboration when addressing areas like quality of care and patient safety. Multi-specialty group practices, like the Guthrie Clinic, are best situated to achieve this true collaboration.  

Though primarily a management tool, this framework can be used in the process of developing a structure for strategic planning. Using this goal-setting model helps guide us as we make decisions about determining our focus for the future. Our recent strategic planning process allowed us to integrate this measurement system into a "dashboard" that focuses us on the steps necessary to achieve the goals of the overall plan.        

For healthcare organizations like ours, their successful future depends on several factors. At the very core of every successful business is the quality of the people that make up that organization. No where is this more important than in a service industry like healthcare. To be the provider of choice in the region we need to both hire and develop the best staff at every level. That needs to be coupled with facilities and technologies that enhance the diagnosis and treatment of disease. These will be critical to deliver superior clinical care. Another area of focus will be to enhance access to care and to organize that to be convenient for patients. The healthcare environment needs to be comfortable and convey a sense of confidence to our patients such that they feel they are in a healing environment.  And, most importantly, we need to do all of the aforementioned in ways that demonstrate service excellence and embody our core values of excellence, teamwork and patient-centeredness.


Joseph A. Scopelliti, MD, is co-CEO, medical affairs for Guthrie Health and president and CEO of Guthrie Clinic in Sayre, Pa. Dr. Scopelliti has served as a practicing gastroenterologist at the Guthrie Clinic and as a clinical instructor with the State University of New York Upstate Medical University at Syracuse since 1984. Since 2005, he has also been associated with the University of Rochester (N.Y.) as an associate clinical professor of medicine.

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