Formation of an Accountable Care Organization

Health care expenditure in the United States is approaching 20 percent of the gross domestic product. National health care spending is projected to increase about 5. 1 % from 2010 to 2020. A more efficient model to health care spending is important to slow the growth of national health care spending. Proposed ideas to reduce the spending are: Shift from a fee for service model to a bundled payment for services; improve health care quality and outcomes; and increase investment in preventing disease and public health initiatives.

The Affordable Care Act has increased the interest in accountable care organizations (ACO). An ACO entails different health providers that work together and are accountable for the quality, cost and coordination of care for a group of patients. Taking into account different organizational management strategies that would lead to the implementation of an ACO, I believe that HealthCare Partners (HCP) is in the best position to be successful.

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HCP has a strong, stable leadership structure and organizational culture, an established and integrated information technology infrastructure, physician support; care coordination capabilities and a process to measure and report quality of care. Leadership and organizational culture: HCP has a strong leadership track record; the founders of the medical group are still in leadership positions. The leaders of HCP promote a culture of openness, accountability and teamwork. The organization encourages a culture of ownership by rewarding physicians for effectively and consistency coordinating care for their patients.

HCP has formed internal and external steering committees to guide the implementation of the ACO. This shows that its members are actively involved in the process and will be part of the leadership of the ACO. Furthermore, the organization encourages innovation and has been involved in national projects to improve payments and delivery of healthcare. Physician support: HCP’s employed providers are aware of the ACO and support it. This is a very important part of implementing the ACO since the providers are key players in delivering the services and monitoring/coordinating care.

HCP recognizes that the IPA physicians are skeptical about the ACO and is developing an incentive plan for the IPA physicians to show their value to the organization. Although the IPA physicians are aware of the HCP culture and vision, HCP is actively working on gaining support from these providers. Infrastructure: An information technology system is crucial for information sharing, analyzing and coordination of care between providers and organizations. HCP has a strong IT infrastructure including a data warehouse which was developed over 10 years.

The capabilities of the HIT include a provider information portal which has allows clinicians to monitor performance on care coordination and quality metrics. They utilize care management programs to coordinate care for patients with chronic illnesses. They can also identify patients that need screening procedures or require follow up for specific conditions. This is helpful for preventing patients from developing complications of their underlying conditions. Payer-Provider relationship: HCP has a good track record with other managed care organizations.

HCP already signed a 5 year partnership with Anthem as its payer and in 2011, Anthem assigned members to the ACO. Anthem also provided HCP with historical claims data and is running an attribution model to identify other ACO patients. The experience in the first couple of years will allow HCP to move toward working with federal programs such as Medicare and Medicaid to coordinate the care of these patients as well as with other payer organizations. Disease prevention system and coordination of patient care: One of the goals of an ACO is to improve quality of care and decrease costs through preventive services and coordination of care.

HCP developed a complex system to target these goals. Its components include: technological support from its IT infrastructure; care management tools, high risk programs and a hospitalist program; performance measurement and development of performance improvement capacity. The IT capabilities allow coordination among providers and care settings which is the basis for achieving the goals of the ACO. Quality and Performance Improvement: HCP’s performance on clinical quality, patient experience, information technology and coordination of diabetes care has been recognized at the state level.

This shows that HCP is already involved in collecting, analyzing and reporting outcomes. Monitoring quality of care and efficiencies for patients within the ACO should not cause added strain to the organization. Based on the above established processes and leadership, I think that HealthCare Partners is on its way to laying the groundwork for how an organization can move toward forming an ACO. As it continues to expand its contracts with other payer organizations, it will be able to provide care to more patients. This would allow HCP to achieve economies of scale by providing the same quality of care to more patients with its infrastructure.

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