WASHINGTON — Nineteen health systems are taking the first steps toward becoming accountable care organizations, joining together to share best practices, coordinate care, and improve quality.
They are all members of Premier Inc., a nonprofit health purchasing and quality improvement alliance. Premier will provide the expertise and databases necessary for the systems to build the accountable care organizations (ACOs).
According to Premier, members of the ACO Implementation Collaborative may be ready in 2012 to start contracting with the Centers for Medicare and Medicaid Services under the shared savings program mandated under the health reform law (Affordable Care Act).
ACOs have been envisioned as the backbone of the new health care system, but they were not clearly defined in the law President Obama signed in March.
At a Capitol Hill briefing, Sen. Max Baucus (D-Mont.), Rep. Earl Pomeroy (D-N.D.), and Rep. Charles Boustany (R-La.) praised the Premier effort, saying that it would help speed up transformation of the health care system into one that values quality over quantity.
Sen. Baucus said that the ACOs in the Premier alliance “put the new and innovative ideas in the health care reform law into practice to improve health care quality while reducing inefficient and wasteful spending.” But Rep. Boustany, a cardiovascular surgeon, said that the reform law did not go far enough to align incentives among health providers or to foster care coordination.
The Premier alliance will address some of these issues, he said, but it still is not clear if the ACO model can work in rural areas where there may be great distances between facilities and disparate missions from urban or suburban counterparts.
According to Premier president and CEO Susan S. DeVore, all members of the collaborative will build the “critical components of accountable care,” including a patient-centered foundation; medical homes that deliver primary care and wellness; incentives to reward coordination, efficiency, and productivity; tight integration among specialists, ancillary providers, and hospitals; reimbursement models that reward value over volume; and health information technology systems to coordinate care across networks.
The 19 systems already have some of these elements in place and can pursue accountability for a portion of their population, according to Premier. These hospitals and health systems have been participating in Premier's QUEST: High-Performing Hospitals collaborative. QUEST is a 3-year information and quality improvement sharing initiative involving 200 hospitals in 31 states. In the first year, hospitals reduced the cost of care by an average $343 per patient. The facilities delivered care according to evidence-based quality measures 86% of the time, according to Premier.
The ACO Implementation Collaborative aims to build on that success. The first step is to define value. According to Premier, the agreed-upon definition so far is to optimize patient outcomes, the patient care experience, and the total cost of care. Dr. Nicholas Wolter, the CEO of the Billings Clinic, which is part of the ACO collaborative, said although ACOs may seem to be a fad, much as managed care was in the early 1990s, more is known now about patient safety and delivering high quality care. “In the ACO, patients are partners working with their care team to manage and improve their health. This is the real goal of health reform—the highest quality care at a more cost-effective price for patients and taxpayers.”
To view a video interview with Dr. Wolter, go to www.youtube.com/elsglobalmedicalnews
Premier ACO Roster to Date
Aria Health, Philadelphia
AtlantiCare, Egg Harbor Township, N.J.
Baystate Health, Springfield, Mass.
Billings Clinic, Mont.
Bon Secours Health System Inc., Greenville, S.C. and Richmond, Va.
CaroMont Health, Gastonia, N.C.
Fairview Health Services, Minneapolis
Geisinger Health System, Danville, Pa.
Heartland Health, St. Joseph, Mo.
Methodist Medical Center of Illinois, Peoria
North Shore-LIJ Health System, Long Island, N.Y.
Presbyterian Healthcare Services, Albuquerque, N.M.
Saint Francis Health System, Tulsa, Okla.
Southcoast Hospitals Group, Fall River, Mass.
SSM Health Care, St. Louis, Mo.
Summa Health System, Akron, Ohio
Texas Health Resources, Arlington
University Hospitals, Cleveland