Frontiers of Health Services Management - Summer 2013 - (Page 31)

Design and Sustainability of ACOs Much has been made of the need for, and indeed the inevitability of, replacing the fee-for-service payment model with bundled, shared savings and global payment models. Some experienced observers have questioned how well new payment models will work, and some have noted the importance of improving the current fee-for-service system. in his discussion of UnityPoint Health strategies, leaver expresses the opinion that new aco strategies are very likely transitional. in an interesting Wall Street Journal colloquium (Mathews 2012), Don Berwick, Jeff goldsmith, and tom Scully discuss their views on aco payment models. Berwick notes that Medicare advantage covers perhaps 25 percent of Medicare beneficia- ries. in his opinion, other Medicare subscribers may benefit from well-managed acos, which typically offer patients more choices than Medicare advantage does as well as improved quality and lower costs. goldsmith sees a “gap between the policy world and the real world.” He cites the high infrastructure costs of aco formation along with a lack of strategy for patient engagement, and he expresses concern about hospitals’ and specialties’ decades-long interest in “making more by doing more.” Scully, too, notes that acos drive more power to hospitals and that “doctors need to drive the bus.” He expresses the view that capitation is a much better option. Both Scully and goldsmith emphasize the need for physicians to improve value through strategies such as the patientcentered medical home (PcMH). and all three call for stronger focus on managing complex, high-cost patients. Both PHc and UnityPoint Health have clearly adopted that strategy. in a recent Wall Street Journal opinion piece, clayton christensen, Jeffrey flier, and vineeta vijayaraghavan (2013) voiced strong concern about the ability of physicians to adopt the necessary new behaviors, the cultural importance of patient engagement, and the unlikely possibility that acos will save money. as an alternative, they advocate more promising “disruptive innovation.” the Billings clinic’s experience in the Physician group Practice (PgP) Demonstration and our early experience in the pilot of the MSSP raises similar concerns. for example, a smaller population, even one of 12,000 beneficiaries, creates a threshold of 3.4 percent before savings are realized. Billings clinic has decided N ic hol a s Wolt e r • 31 C o m m e n t a r y recognize the indispensability of granular data to drive the timely decision making required to create a culture of continuous improvement. Many US healthcare organizations lack the decision support information they need and must make do with largely retrospective and less-than-accurate granular data about specific procedures or admissions. By combining insurance claims data with their own clinical data to gain a clearer picture of how and where patients receive care and how fragmented care affects outcomes, UnityPoint Health is taking an important step in the right direction. even when accurate and timely data are available, however, many clinicians find electronic health record (eHr) tools to be underdeveloped and frustrating, and the clinical eHr must also be significantly upgraded to assist with the safety and quality improvements needed in patient care.

Table of Contents for the Digital Edition of Frontiers of Health Services Management - Summer 2013

Frontiers of Health Services Management - Summer 2013
Contents
Editorial
At the Heart of Integration: Aligning Physicians and Administrators to Create New Value
Volume to Value
Physician-Led Models of Accountability and Value: Observations on Payment Policy and Culture
Collaboration Across Clinical Silos
Breaking Down Clinical Silos in Healthcare

Frontiers of Health Services Management - Summer 2013