As Interest in ACOs Wanes, It's Time to Do the 'Next Right Thing'

Like many other hospitals, we had been seriously considering implementing an accountable care organization. It seemed like the right thing to do to meet the needs of patients. The purpose was to make healthcare more efficient by integrating hospital care with that of physicians and other outpatient providers.


But now — like many other hospitals, as well — we have dropped plans for an ACO because the proposed regulations are too complex. However, we have not given up looking at the future or pursuing "the next right thing," which would incorporate many of the objectives of ACOs without actually becoming an ACO.


To do this, we need to go back to our fundamental goals, which are meeting the needs of the patient and moving toward integration of health services. Hospitals also face the same challenge as before — to become more efficient, because there will be funding cuts. Here are a few examples of the steps hospitals can take to do "the next right thing."


Focus on patients. As hospitals readjust their goals, the guiding light should be meeting the needs of patients. We should start re-examining the patient experience and match it up with our delivery system. Nationally, the healthcare system is beginning to recognize the positive influence of patient experiences on quality. We need to engage in more patient outreach, such as making sure medications are used, educating patients on compliance and providing support. The goal should be patient literacy.


Study community needs. Paying attention to the needs of the community is fundamental. In fact, this is an obligation for non-profit hospitals such as our own. Our non-profit status brings with it a fiduciary obligation to the community. We need to keep trying to gain the trust of patients and the community at large. With this in mind, our two hospitals have launched a new strategic plan, "Imagining the Future: 2016," engaging community members in helping create our five-year strategic plan.


Partner with payors. Many hospitals and other providers are working with Medicare Advantage plans to improve efficiency and quality. Providers have also begun working with private payors to create ACO-like arrangements. As part of the deal, hospitals can tap into payors' rich database for metrics, such as how many times patients have seen their physician or whether the patient got her mammogram on time. The hospital might have some of this information, but it is not as integrated as the data payors have.


Get physicians engaged. Everything I see and hear is about the need to engage physicians. As hospitals employ more physicians, they will need help from us to be more effective. Hospitals need to train physicians on how to operate within the organization and to get decent payor contracts. We also need to streamline management of employed physicians. Instead of managing 100 physicians separately, it's more efficient to organize them into several groups. Hospitals are also setting up medical director agreements to get independent physicians into leadership roles and creating co-management agreements with them.


Create physician-led systems. Hospitals need to go deeper than just making deals with physicians. Physicians should be involved in the highest echelons of hospital leadership and help us create our strategic vision. It's essential to bring physicians into the mission itself and create physician leaders. In the future, physicians will be expected to carry the strategic vision of the hospital or health system. This means more physicians becoming hospital CEOs or working in close partnerships with non-MD CEOs. Making these arrangements successful means choosing the right physicians for leadership roles.


Adopt the medical home. Under the patient-centered medical home, each patient is given a personal physician, providing first-contact, continuous and comprehensive care. The physician assumes responsibility for either directly providing the patient's healthcare needs or arranging care with other qualified professionals. This is a critically important step between going from pay-for-procedure to pay-for-population healthcare.


Help physicians find new models of care. As hospitals and physicians move closer to each other, physicians should still be encouraged to be innovative and entrepreneurial. For example, more physicians are getting involved in "concierge medicine," which involves charging patients a direct fee and dropping out of Medicare and private insurance. Our health system is also starting to place family physicians at the worksite as a way to help employers reduce emergency and urgent care visits, lower absenteeism and improve employees' overall health status.


Another worthwhile innovation is putting ancillary testing and other outpatient services in the same building with physician offices. This is convenient for the patient. The physician office building can also be a hub for other activities such as expert-led groups on behavior-changing regimens like weight control. Our hospital is involved in planning a physician office building that will include a gym along with several ancillary services. Since 80 percent of the public does not go to a gym, this could be an important step in improving patient wellness.


Improve IT. Hospitals need to keep growing their IT systems. IT has to be linked to outpatient centers and physicians' offices and plugged into insurance information. The data needs to be mined to give physicians information on how to make clinical improvements, which requires a great deal of software to organize the information.


Continue working on centers of excellence. A lot of people are predicting that all tertiary care will go to nationwide centers such as Mayo Clinic, which is only 100 miles away from us. But I believe there will always be a demand for locally grown tertiary care as long as it is of high quality and has sufficient volume. The amount of volume, however, does not have to be as large as some people think. For example, we have expanded our neurosurgery service into full-spectrum neurosurgical care. This involved making substantial investments in state-of-the-art technologies, including two "smart" operating suites equipped with advanced intra-operative imaging and 3-D mapping capabilities.

Put UR front and center. It's time to take utilization review out of the basement of the health system and put it into the executive office. With new requirements like reducing readmissions, UR tasks such as discharge planning are more important than ever. Hospitals need to improve relations with rehab centers, nursing homes and home health agencies for the whole continuum of care. These decisions need close collaboration with the C-suite. The UR director should be in the hospital's leadership group, and the UR department should be regularly reporting to the CEO.


Create new delivery models. As pressures mount to lower costs, we need to come up with innovative models to deliver care. For example, the least costly venue for care is the patient's home, so it is important to find ways to monitor patients in the home. Home-monitoring technology has been progressing rapidly, and we need to take advantage of it.


Steve Ronstrom has more than 25 years of hospital leadership experience, having served for the past 12 years as an executive in the Hospital Sisters Health System. He is currently president and CEO of the Hospital Sisters' Western Wisconsin division, which comprises 344-bed Sacred Heart Hospital in Eau Claire and 193-bed St. Joseph's Hospital in Chippewa Falls. Learn more about Hospital Sisters Health System.


More Articles From Steve Ronstrom:

The Challenge of Non-Profit Status in an Era of Accountable Care

Putting Communities in Charge of Hospitals' Future

The Case for Shifting More Services to Midlevel Providers


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