The Analytics Behind Tucson Medical Center's New Sustainable Health Community

Tucson Medical Center launched an accountable care organization, Southern Arizona ACO, in 2010. Last week, the hospital and health technology services company Optum announced the creation of a new project focused on coordinated care: the Sustainable Health Community. TMC has partnered with Optum to launch this model, which is based on ACOs but slightly different. Todd Cozzens, CEO of Optum's accountable care solutions business unit, explains the nuances between the two models, the types of analytics in use and how ACOs may become more patient-centered over time.

The Sustainable Health Community is a commercial/public model and broader than an ACO, according to Mr. Cozzens. "An SHC means a model of care that is sustainable with intense focus on the triple aim: outcomes, cost-reduction and improved patient and caregiver satisfaction, which engages the entire community — not just silos of care," says Mr. Cozzens. "An ACO is really a stricter acronym for the CMS-sponsored version of a SHC," says Mr. Cozzens. By partnering with Optum, TMC has increased its data and analytics capabilities with a focus on the following three categories:

Population management. Through analytics tools, the SHC will identify gaps in the care process and areas that might have weaker levels of care in the community. "This really looks at where care can be improved," said Mr. Cozzens. It will collect and examine data such as where the sickest patients reside and what diseases are about the national average in terms of occurrence. Armed with this information, the SHC can then make a predictive model to better tailor its care to the community's needs.

Physician performance. Optum will provide tools to keep Tucson Medical Center and independent physicians connected, aligned and informed. With the population's needs identified, these tools will help physicians' decisions at the point of care and transition to evidence-based medicine. Physicians participating in the SHC have agreed to be measured and rewarded based upon their delivery of high-quality patient care, patient satisfaction and reduced costs.

Care management. Finally, a third tool will follow patients and the care practices they receive throughout the entire duration of a disease. This tool will also monitor transitions of care between providers and identify any potential weak spots.

Together, these tools allow medical centers like TMC and its independent physicians to develop shared-savings incentives focused on quality and outcomes rather than procedures and transactions. "We've seen the mind shift in the clinicians at TMC for this new model of care, and the sheer liberation they go through in understanding that they finally get to take care of patients the way they were trained to rather than what fee-for-service business demands dictate," says Mr. Cozzens.

Mr. Cozzens said these tools are separate from electronic medical records. "Those just record information about what happened to the patient. They don't really manage patients through a disease or longitudinal episode of care," says Mr. Cozzens. Some of the care protocols Optum develops, however, can be built into EMRs. Along with the data tools, Optum has also developed four offices — for analytics, technology, contracting and care coordination — in alliance with TMC, providing infrastructure to the SHC model.

Noting that Tucson Medical Center is already well into its ACO, Mr. Cozzens says coordinated care models are likely to become more patient-centered over time. "Patients will eventually take more control of their own care," says Mr. Cozzens. "The first step is making the care process in inpatient and outpatient settings more efficient, connected, intelligent and aligned." Along with healthcare analytics and data tools, Mr. Cozzens says a rise in tools and products on the web will help patients take the reigns of their own healthcare delivery. Optum also has tools to help hospitals proactively prevent readmissions and reduce ED utilization.

Of course, as a commercial model, the SHC can continue to move forward while CMS' proposed rule is still being finalized. "Those rules saw a lot of pushback," says Mr. Cozzens. "We believe a lot of those issues will probably be resolved. This is not about regulations — the need to manage patient populations and make the care process work more effectively is upon us and presents great opportunity for us," says Mr. Cozzens.  

Related Articles on ACO Analytics:
6 Building Blocks of a Technology Framework for ACOs
7 Performance Measures Essential for ACOs, Other Payment Reforms
Analytics for ACOs: Measuring the Depth Before Diving In







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