ACO Growth Summit Recap

The 2014 ACO Growth Summit conference (which just concluded on Tuesday) was well-attended and represented ACO players from coast to coast. I was particularly impressed by the active and engaged audience:  they were clearly attending because they were intent on picking up some pearls of wisdom from the extraordinary speakers which included administrative leaders and physician groups from both Medicare and Commercial ACOs. 

Unlike some conferences I have seen, the speakers shared their experiences at a much deeper level than often is the case.  They avoided simple generalities and did not leave the audiences with just conceptual outlines.  Speakers shared generously from their own experiences and the audience eagerly asked questions to expand on their understanding of the topics (for example):

  • Contracting with health plans
  • Establishing quality metrics and benchmarks
  • Leveraging technology
  • Population health strategies
  • Decisions to play or not to play in the Medicare ACO game
  • Engaging and involving physicians in governance, strategy and in-the-trenches
  • Macro reporting and data management tools
  • Creating a Culture of Accountable Care and achieving buy-in

The ACOs represented at the conference had varying levels of experience and were at differing places along the development continuum.  In most cases, the information presented was helpful to layout the kind of work that will be necessary to succeed, although some were more ready to adopt ideas than others depending on how much progress they had already made.  In some cases, it was clear that the work ahead is going to be daunting.  

There were important themes and areas for further work:

  • Hospitals struggle with the commercial ACO strategy because there is not a clear case for an ROI
    • Reducing hospital admissions and bed days means less hospital revenues
    • Will gain sharing offset the net revenue fall-off?
    • Given the ambiguity of the answer to this question, can hospitals get behind the strategy?  Or will they become an obstacle that ensures failure?
    • Academic medical centers:  unique challenges of institutions with teaching programs and tertiary/ quaternary care
      • How do you reconcile the teaching mission vs. business mission of ACO?
      • With physicians who are faculty, house staff, and other affiliated physicians from outside the institution, how are the missions and cultures aligned?
      • What kind of infrastructure needs to be in place in order to accomplish meaningful use requirements and functionality to support patient-centered medical homes?
      • Is it realistic to pit themselves in competition with community hospitals given the cost structure of teaching institutions
      • How can they overcome the adverse selection due to reputations for tertiary / quaternary care?
      • Commercial PPOs using ACO delivery systems
        • In order to fulfill the accountability requirements, how to overcome timeliness challenges of real-time care coordination, especially out-of-network services?
        • How to overcome the shortcomings of attribution models for inferred Primary Care?
        • Given the current lack of safe-harbor protection for gain-sharing, what is the outlook for the success of this model?
        • Ultimately, will ACOs endure as a form of organizing and financing healthcare, or will the future look very different?
          • Achieving the Triple Aim through accountable care vehicles requires a total transformation of the health care delivery system and its processes
          • The infrastructure and time investments are enormous
          • The consumers do not understand the concept and therefore are not asking for it
          • Is the investment in this form justifiable if it is the end-product or is the ACO a transitional form like a bridge leading to a more robust model?  And if so, what will that look like?

I was convinced by the conference that these key drivers are going to persist for the foreseeable future.  A great deal of learning and knowledge transfer is going to have to take place in a compressed timeframe in order for the insights to diffuse through the health care system and take root.  At the end of the day, I also came aware believing that we have passed the Rubicon:  the point of no return is in our rear view mirrors. Steering ahead is the only option, but there is a significant need for venues to share best practices.  Healthcare Education Associates and their sponsors are poised to make a significant contribution to this knowledge transfer and networking imperative. 

I want to acknowledge the great speakers and panelists from the Healthcare Education Associates event:

  • Jordan M. Hall, Director of Population Health Management and Comprehensive Care Coordination

UCLA MEDICAL GROUP

  • Juan Lopera, Director of Health Care Services, Strategy & Analytics

TUFTS HEALTH PLAN

  • Terri Thompson, Vice President, Population Health

PROMEDICA

  • Steven Baratta, Assistant Vice President, Alternative Payment and Integrated Care Networks

HEALTH MANAGEMENT ASSOCIATES

  • David Cook, Chief Administrative Officer

PROHEALTH SOLUTIONS, LLC

  • William Patten, DVP Network

BLUE CROSS BLUE SHIELD OF ILLINOIS

  • Peter Bacon, System Vice President Business Development/Dean Export

DEAN HEALTH PLAN

  • Mark Casmer, Interim President/CEO

MEDICAL ADVANTAGE GROUP

  • Hans Wiik, President

IPN CENTURA HEALTH

  • Gregg Allen, Executive Vice President, Chief Medical Officer

MEDSOLUTIONS

  • Norman A. Scarborough, MD, DABR, Vice President & Senior Medical Director

MEDSOLUTIONS

  • Heather Orth, RN, BSN, Director of Accountable Care

DEACONESS CLINIC

  • J. Peter Rich, Partner

MCDERMOTT WILL & EMERY LLP

  • Paul K. Schnur, Vice President, Provider Contracting

HAWAII MEDICAL SERVICE ASSOCIATION, INDEPENDENT LICENSEE OF BLUE CROSS AND BLUE SHIELD ASSOCIATION

  • Linnea Chervenak, Administrative Director, Population Health Office

UNIVERSITY OF MICHIGAN HEALTH SYSTEM

  • Andrew Snyder, MD, Chief Medical Officer

BROWN & TOLAND PHYSICIANS

  • Mary Folladori, RN MSN FACM, System Director, Care Management

MHMD - THE MEMORIAL HERMANN PHYSICIAN NETWORK

  • Andrew Snyder, MD, Chief Medical Officer

BROWN & TOLAND PHYSICIANS

  • Chris Stanley, MD, Vice President, Care Management

CATHOLIC HEALTH INITIATIVES

  • Brandon Franklin, Vice President of Health Connectivity Services

COMPUGROUP MEDICAL US


Categories: Accountable Care
Tags: ACOs

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