Frontiers of Health Services Management - Summer 2014 - (Page 37)

many express confusion or a desire to gain a more thorough understanding. accordingly, we are working to develop the form and content of appropriately tailored population health education for our providers as well as for our patients and the community. Accountable Care: Learning While Doing Much like Zenty, Bieber, and Hammack, we have piloted several accountable care opportunities, all treated as disciplined experiments with the intent of refining our capabilities in preparation for assuming downside risk: Population Health (Not Just Healthcare) operating as a Medicare Shared Savings Program aco, building an employee aco, working with private payers to develop new commercial aco arrangements, offering bundles to the marketplace, and ramping up an enterprise-wide care coordination program all depend on a population health management infrastructure that continues to require significant investment in personnel and information technology. We have successfully built such an infrastructure, but we know our work is not nearly done. a focus on clinical care and clinical integration is C hr is t op he r Da dl e z , FAC H E * 37 C o m m e n t a r y * Employee ACO. in an effort to both manage our own spending as a selfinsured employer and create a model of what we could do for other large employers, we contracted with Saint francis Healthcare Partners to create an employee aco. the principles of accountable care were implemented for 6,500 members, and the combination of plan design changes, care coordination interventions, and wellness incentives yielded a tangible reduction in our cost trend experience. * Medicare Shared Savings Program ACO. in January 2013, Saint francis Healthcare Partners was awarded a centers for Medicare & Medicaid Services (cMS) aco contract covering 20,000 lives. as data from cMS has been fed into our claims data warehouse, we have developed new analytic competencies. in addition, we have embedded care coordinators in our large physician practices and used a public utility model to provide care coordination from a central source for our smaller practices. * Commercial ACOs. Private payers quickly got up to speed with accountable care payment mechanisms. in the past year, Saint francis Healthcare Partners entered into two commercial aco arrangements, covering another 55,000 lives. Both of these commercial agreements have similar structures based on a total cost of care (i.e., population health management) model. * Bundles. cJri is a leading-edge program on a number of levels; for example, it offered one of the first bundled products for hip or knee replacement in the United States. these joint bundles include payment for surgeons, anesthesiologists, and the hospital. an additional postsurgical warranty rider is also available. * Care coordination. Saint francis employs a structured care coordination model, with staffing based on national norms. covered lives are stratified by health risk, and health coaches are assigned to the highest-risk patients for interventions. Mechanisms to address gaps in care, transitions in care, eD follow-up, and discharge appointment follow-up are all part of the program.

Table of Contents for the Digital Edition of Frontiers of Health Services Management - Summer 2014

Table of Contents

Frontiers of Health Services Management - Summer 2014