The Accountable Care Alliance, as it has been named, is the first known effort by two competing hospitals to join together for the purpose of creating an ACO. Its goals include increasing communication between physicians and hospitals, reducing duplication of services, limiting unnecessary tests while improving overall quality, managing transitions from hospital to home care, reducing hospital admissions and decreasing overall healthcare costs.
While the two hospitals are competitors in the Omaha market, they have worked together for many years to train University of Nebraska Medical Center resident physicians. “While we compete for patients in the community, there are many commonalities between the two [systems], says Dennis Goeschel, MD, ACA board chairman and medical director of ambulatory services for UNMC Physicians, the UNMC faculty physician group. “We have a common vision that we need to change the way we provide high quality, cost effective clinical care. The alliance allows us to share the necessary expenses and expertise.”
The expense and effort required for the development of any ACO is significant. Not only can start-up legal fees be extensive due to numerous governance and contractual issues that must be addressed, but heavy involvement by physicians is also needed to determine clinical best practices. After best practices are developed, they need to be monitored and clinical outcomes must be analyzed — processes made easier with an integrated electronic health record system, which is another significant expense to providers affiliated with the ACO. Dr. Goeschel says having an integrated EHR is a challenge for the ACA, as The Nebraska Medical Center and Methodist currently have different EHR systems.
Governance
The ACA is overseen by a 12-member board, split evenly between representatives from The Nebraska Medical Center and Methodist. The board is composed mostly of physicians, with each system’s CFO completing the group. The physicians include both faculty physicians from UNMC and independent physicians from both hospitals.
The board oversees a number of committees, including the medical management committee, which will be critical as the ACO develops and implements best practices for patient care.
How it will work
The ACA is now just about six months old, so it has yet to finalize any specific proposals from payors, but it has begun to reach out to them regarding possible contracts for reducing admission rates and bundled fees between hospitals, physicians and other providers for certain procedures, such as joint replacements, says Dr. Goeschel. “Payment reform is being driven by public payors, but there seems little doubt private payors will also be involved in some manner,” he says. Although the two systems have partnered to create the ACO and will split expenses evenly, they will separately recoup any savings they create by better managing patients (i.e., proceeds possibly will not be evenly split between the two groups), says Dr. Goeschel.
The ACA also needs to recruit members of each hospital’s medical staff and, eventually, patients who will call either Methodist or The Nebraska Medical Center their “medical home.” Dr. Goeschel says participation in the alliance is voluntary, but he hopes most physicians do decide to participate.
What lies ahead
The ACA is not yet fully functional, but it appears to have a head start in meeting the requirements for participating in ACO demonstration projects. Many questions have yet to be sorted out, and one of the most common questions is what will happen when patients go outside their ACO. Dr. Goeschel feels The Nebraska Medical Center and Methodist made the right decision to set up an alliance as early as they did. “What is clear is that we are going to be reimbursed differently in the future, and I personally think fee for service will decrease or disappear, particularly in large, urban areas. Payment will be based in part on how well we provide and report quality, and we will see more bundled payments, payments for episodic care and capitation,” he says. “I don’t see how we can avoid these changes, but we can do something about them and try to get ourselves prepared to respond to them. Physicians and hospitals are going to have to partner together and take joint responsibility for the care of their patients.”
Learn more about the Accountable Care Alliance.
