Embracing Accountable Care: 5 Tips From Tucson Medical Center CEO Judy Rich

Judy RichCMS announced last month its anticipated list of the first 27 accountable care organizations selected for the Medicare Shared Saving Program. CEO Judy Rich of Tucson (Ariz.) Medical Center, the medical center in Arizona Connected Care, one of the 27 original CMS MSSP participants, shares five points for leaders who are either part of a newly formed ACO or looking to form one in the near future.

1. Make sure that the governing board understands and accepts the risk domain. While accountable care organizations in one form or another are part of the forecasted future of healthcare in the United States, there are specific challenges ahead. "This model is designed to be more efficient," Ms. Rich says. "Shorter and less invasive hospital stays will become the norm."

Thus, the basic model many hospitals have survived on — inpatient care, filling beds — is at risk of being upended by ACOs. It's understandable then why some hospital leaders are uneasy about making a shift to accountable care organization. There will be a drop in utilization, and hospital stays will become shorter, treatments less invasive.  Still, this change in hospital strategy is good for the community and good for the patient, says Ms. Rich. She had to explain the importance and utilitarian benefit of accountable care to Tucson Medical center leaders.

"What we needed to inform our board and physicians of is how we are going to manage the patients so that shared savings will, in fact, come back to us," Ms. Rich says. Hospitals that anticipate less bed stays and manage the shift effectively while providing the best quality of care will succeed. Patients are likely to want treatment from a hospital looking to give them care as efficiently as possible without sacrificing quality. In the MSSP, ACOs that cut cost and can prove improvement in patient care through data will receive bonus pay. Hospitals that integrate care models to the point where patients spend as little time in the actual building as necessary may reap further shared savings rewards as more private insurers implement quality of care contracts.

2. Leverage technology, but do not lose sight of the human component of healthcare. A hospital could be incredibly efficient at gathering patient data and entering it into organized and well managed, databases — but if hospitals don't consider data a means to an end — that end being patient care — the data is in some ways a moot point. "We will fail if we misinterpret the role of the patient," she says. Technology is intended to empower care providers, not replace them.

Giving patients support at home instead of keeping them in the hospital is one way to keep the patient at the center of care. "Congestive heart failure is a perfect example of a chronic disease that puts people back in the hospital," Ms. Rich says. Nearly one out of every four patients with congestive heart failure is readmitted to a hospital within 30 days of treatment. Technology can assist ACOs to stay better connected to patients at home through the use of telemedicine communication.

3. Align with good partners who share the same vision. It's essential to maintain positive and constructive relationships with physician partners in an ACO. All partners need to have "the willingness to redesign the healthcare system," Ms. Rich says. "Our physician partners are committed to the success of our ACO."

There's been a project team on the ground in Tucson, employees of health technology company Optum, helping Arizona Connected Care structure how it will share patient data and organize information technology across all partner channels in the organization. Ms. Rich says Optum "provides technology and resources that would have been out of our reach just a few years ago" and helps the Arizona ACO "link all the pieces and share the same data."

Ms. Rich says it's important to make sure all partners — physicians, nurses, health plan administrators — are on board with the ACO mission to provide quality long-term care at a lower cost. Ms. Rich refers to this as sharing in a philosophical belief that, together, all healthcare partners involved in accountable care can change the world. "We've accepted healthcare the way it is for so long," Ms. Rich says. "What we would like to say through our partnership is that we can manage and create healthcare in a totally different manner."

But perhaps one of the most crucial partners in the ACO, and one that's not always discussed in terms of actually being a partner, is the patient.
"Arizona Connected Care’s success will be based largely on the partnerships we are able to build with our patients," Ms. Rich says. "Personal accountability and engagement of the patient in the continuum of care is critical."

4. Ensure the ACO aligns with your community's health needs. Tucson is a diverse community full of unique needs, notes Ms. Rich. There's a 50,000 student university — the University of Arizona — and that population has a number of unique healthcare demands. The city boasts a large military population, including veterans and active members on several bases in the area.  Tucson is also home to many small and mid-sized businesses looking for affordable healthcare plans to provide for employees. Ethnically, 50 percent of the population is Hispanic. Arizona Connected Care, like any working ACO, needs to address the cultural uniqueness of its entire patient population, says Ms. Rich.

"We are the only hospital in the region to have onsite, employed Spanish-language interpreters who work directly with the clinical staff to communicate to our patients who speak primarily Spanish," she says.

The translators help Spanish-speaking patients better understand discharge instructions, which allows for a smooth transition for patients when they return home.

To get an ever better understanding of its population's needs, the hospital studies data and looks for trends within its various populations. After analyzing data, Tucson Medical Center noticed that Hispanic men in the community were falling more frequently than other members of the Tucson population. To address the fact that Hispanic men are statistically less likely than others to ask for help when walking, the medical center is "working on culturally sensitive processes to make that 'ask' easier and, in the end, reduce falls for those patients," Ms. Rich says.

Knowing care factors such as these before forming an ACO is essential — it will help healthcare leadership craft integrated care models specific to the people it represents. The community, in turn, will probably appreciate the benefits of smart care. Moreover, in theory, accountable care will make for a more cost effective healthcare experience. "We have a lot of respect and consideration for what our own population's needs are," Ms. Rich says.

5. Coordinate with ACO participants to keep patients satisfied during hospital stays. To help provide for patients' needs, Tucson Medical has a full-time care coordinator who helps find ways to make patient stays better. Her job is to discover for every patient "the magic ingredient to keep that person happy," Ms. Rich says. The care coordinator may ask questions such as: Is the patient lonely? Does his or her food have too much sodium? Is there a previous health condition making the patient disgruntled? It's then the responsibility of the care coordinator to find answers to those questions — she figures out ways to provide for the specific behavioral and emotional needs of all patients and works with other members of the integrated care team to deliver the best end result possible.

While these tips will help an ACO start its journey, the more arduous task is ensuring patients stay healthy. Patients too need to be held accountable in order for an ACO to fulfill one of its long-term goals, improving population health. "One of the biggest risks we have is the risk of not being able to change the day-to-day health habits of our population," Rich says. "We have to find out how to motivate people to be healthy."

More Articles on Accountable Care Organizations:

7 Steps to Navigate Payment Allocation Under ACOs
8 Biggest Mistakes an ACO Can Make
The ACO Game of Wealth, Power and Local Politics

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