An Oncology ACO from the Hospital's Perspective: Q&A With Baptist Health CFO Ralph Lawson

Health insurer Florida Blue recently partnered with Coral Gables, Fla.-based hospital Baptist Health South Florida and Miami-based oncology group Advanced Medical Specialties to form an accountable care organization aimed at providing care for cancer patients in South Florida. The group is the first oncology ACO in Florida and one of the first oncology ACOs in the nation.

Florida Blue's CMO shared insight into the process of forming the oncology ACO in a recent Q&A with Becker's Hospital Review. Here, Ralph E. Lawson, CFO and executive vice president of Baptist Health South Florida, discusses the oncology ACO from the hospital's perspective.

Q: Why did Baptist Health choose to get involved in an oncology ACO?

Ralph Lawson: Simply put, healthcare costs too much. As providers of care, we have the responsibility to lead industry efforts to increase quality and decrease costs. There are tremendous opportunities for hospitals, payors and physicians to align and collaborate to develop and implement the foundations necessary to accomplish these sea changes, and Baptist Health desires to be at the forefront of these important changes.

Q: How has the collaboration worked so far with Florida Blue and Advanced Medical Specialties?

RL: We are only about one month into the actual term of the collaboration, but our experience working together during the planning, development and implementation stages has been extremely positive. All three organizations share very similar views on how we can develop innovative ways of providing high quality, affordable healthcare to the patients and communities we serve. The foundation of our collaboration is based on transparency and trust. We have developed our relationships with each other to foster an environment of working together, even on the traditionally hard stuff, to come out with an end result that will ultimately benefit our patients.

Q: What is your hospital's specific role in the ACO?

RL: The tripartite nature of the ACO collaborative tends to blur the roles between the participants. Many of the initiatives can only be accomplished by Baptist Health, Florida Blue and Advanced Medical Specialties working in concert. Nonetheless, the physician definitely plays the lead, but all parties are keenly focused on increasing quality and reducing costs — and incorporating that into their respective roles.

Q: What is the leadership structure of your oncology ACO?

RL: The senior leadership at each of the three organizations is actively involved and engaged in the strategy setting of the oncology ACO. Additionally, members of our respective teams serve as project managers and hold weekly meetings to review data and maintain adherence to timeframes and initiatives. Even though there is no separate governance or leadership structure dedicated solely to the oncology ACO collaborative, guidance and goal setting in the area of clinical value improvement is primarily driven by the physicians of Advanced Medical Specialties and the medical leadership at Florida Blue.

Q: How has data sharing worked in the first month of the organization?

RL: We anticipated the first several months of this agreement to be dedicated to identifying opportunities to impact quality and cost through data mining. Florida Blue provides informatics on the target population and, with heavy input from Advanced Medical Specialties, we are refining data extracts to hone in on targeted opportunities.

Baptist Health's and Advanced Medical Specialties' information technology teams are also working diligently on the development of appropriate and compliant processes to achieve more real-time sharing of target population information for emergency visits to Baptist Health facilities, in order to avoid duplication or unnecessary diagnostic testing.

How might future shared savings benefit Baptist Health?

RL: Doing the "right thing" — for example, reducing length of stay or performing traditionally inpatient stay procedures as outpatient — is important to Baptist Health. But as the CFO of the largest non-profit healthcare system in South Florida, I can tell you with certainty that doing the "right thing" oftentimes translates to lower reimbursement for the hospital. But, there is no doubt in my mind, we as an industry must do the "right thing," and arrangements like this allow us to do just that. Shared savings arrangements serve to align the incentives of all parties responsible for impacting healthcare spending so that we are able to reduce our costs, which is critical in light of reduced reimbursements.

What advice would you offer other hospitals looking to join a specialty ACO?

RL: The importance of choosing the right partners is the key. In order to effectuate change in the areas of quality and costs, all parties must be willing to be open and transparent with each other. It is all about the relationships, and the ability to adapt to the nuances of the "new normal" as our industry transitions from volume-based to value-based reimbursement methodologies.

Have you considered forming partnerships with other specialty ACOs?

RL: Yes. We are currently evaluating opportunities in the areas of cardiothoracic surgery and cardiology.

More Articles on ACOs:

Baptist Health South Florida, Florida Blue and Oncology Group Form ACO
7 Recently Formed ACOs
3 Biggest Obstacles for ACO Structures: Capital, Engagement & Leadership

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