Frontiers of Health Services Management - Summer 2014 - (Page 49)

and incorporates critical design elements into the overall approach. for example, they demonstrate that using strategically located, after-hours telemedicine kiosks for pediatric patients helps reduce barriers to care and provides consumers with less expensive alternatives to in-person or emergency room services. in the context of the Kindig-isham paradigm, which requires a consortium of community partners with the goal of affecting the broader social determinants of health, acos will be insufficient to achieve that goal. nonetheless, i argue that although acos are not the "end game," the accountable care movement can be a strategic vehicle to facilitate broad change. acos can serve as a laboratory to aid clinical delivery systems in developing the infrastructure needed to improve efficiency and effectiveness and experiment with risk management. as communities begin to address health needs more holistically, clinical systems will be better informed partners with more skills and knowledge, gleaned in part from the effort required to align clinical and financial incentives and engage diverse stakeholders within their organizations. ACOs as Laboratories for Change Management an aco, especially one that involves a combination of hospital leaders, various types of physicians, and community support organizations, must bring together stakeholders who do not necessarily have a common language, a shared vision, or fully aligned incentives. an aco is responsible for improving clinical outcomes within a defined budget, and similar to other risk-bearing entities, it prioritizes resources to meet objectives. resources will be limited, and debate, conflict, and D ia ne P . H ol de r * 4 9 C o m m e n t a r y year of Medicare's quality incentive program, more hospitals received penalties than did those that earned bonuses (rau 2013). to reverse that trend, outcomebased payments that emphasize a reduction in preventable readmissions require a significant redesign related to follow-up care and proactive management of chronic illness. another dynamic related to the valuebased reimbursement model is consolidation. Significant merger activity is occurring among hospitals as they confront revenue compression and the need to build infrastructure to address the cost and quality requirements of the aca. in the third quarter of 2013, 20 percent more hospital mergers took place than in the same period of 2012, and the pace is expected to continue in 2014 (casper 2014). also evident is an increase in the number of providers developing payer functionality (advisory Board company 2012) and the number of payers acquiring providers (vesely 2012). at the center of these activities is an industry attempting to protect itself while it prepares for greater challenges. ending the ffS payment model is championed by many, including the national commission on Physician Payment reform, whose 2013 report calls for an end to ffS within seven years and provides a five-year blueprint for transitioning to a blended payment system (national commission 2013). for providers that do not operate their own health plan, aco development is one method by which to experiment with new payment models. in their feature article, Zenty, Bieber, and Hammack provide an interesting example of how one organization is tackling the developmental requirements. their work focuses on clinical transformation and governance

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Frontiers of Health Services Management - Summer 2014