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Blue Cross, Lifespan and physicians group form ACO

riblue

Blue Cross & Blue Shield of Rhode Island’s headquarters, in downtown Providence.

Three  Rhode Island healthcare organizations, Blue Cross & Blue Shield of Rhode Island, Lifespan, a large hospital system, and Coastal Medical, a physicians group, have created an Accountable Care Organization to serve  45,000 patients.

The agreement aims to  improve how primary, specialty and inpatient care are delivered in the tiny but densely populated state.

The Providence Business News reports: “The pact offers incentives that reward enhanced care management and more efficient delivery of care for the 45,000 Blue Cross members who receive their primary care from Coastal Medical providers. The effort is expected to result in better health outcomes, lower costs and better service to patients, according to the deal participants.”

The paper said: “Blue Cross, Coastal and Lifespan will remain fully independent under this agreement, but each will work with the others in a more aligned fashion than ever before.”


Touting a successful care-coordination venture

scottsdale

In the Scottsdale Arts District.

This Physicians Practice article touts  the  care-coordination  model of Scottsdale Health Partners (mostly serving the rich Phoenix suburb of Scottsdale) — a joint venture between  the HonorHealth hospital system and about 700 physicians.
The publication says that “The clinical integrated network and Accountable Care Organization (ACO) is a primary example of how hospitals and physicians can successfully work hand-in-hand in a value-based environment. SHP has enjoyed success in achieving its goals of improving quality of care and lowering costs. In particular, it has reduced its hospital readmissions rate to 9 percent, well below the state average of 15 percent, and saved up to 10 percent in medical costs for its population of 40,000 patients.

“For physician practices looking to get a jump start on value-based care, before CMS’s Merit-Based Incentive Payment System’s (MIPS) likely first performance year in 2017, SHP can be a source of inspiration. Since starting up in 2012, it’s found a way to use technology and personnel to coordinate care almost seamlessly from the hospital to the practice-level.”

Impressive indeed, but a major factor in its success is that the Scottsdale patient population includes many very affluent people with lots of very good health insurance.

 


Don’t depend on financial carrots in healthcare

 

Thomas Dahlborg, writing in Hospital Impact, warns about what he sees as the problems in depending on financial incentives in healthcare.

…{A}s we continue to move from productivity-based reimbursement to quality-based reimbursement via the Accountable Care Organization and other payment reform models, a large caution sign is illuminated before me.

“And of course this led me to the Harvard Business Review and “Why Incentive Plans Cannot Work”.


1.
“Rewards do not create a lasting commitment. They merely, and temporarily, change what we do.

2.
“People are likely to become less interested in their work, requiring extrinsic incentives before expending effort.”

“In addition, it’s very important to me as a patient, as a family member of patients and as a healthcare leader to know that those who are caring for those I love are doing so because they truly care–and not because they are being financially incentivized to do so. ”

“Yes, perhaps the financial incentives will change behavior (temporarily), and perhaps it will even have an impact on HCAHPS and other satisfaction and experience scores. But even if those scores were not affected only temporarily, do you really want a healthcare system to be driven by financial rewards rather than an enduring commitment to quality and safety by people who truly care?”

 

 

Financial incentives may temporarily change outcomes, but they do not change hearts.

  • Let’s not edge the humanity out of healthcare via over reliance on financial drivers of change.
  • Let’s focus on changing adaptively rather than with a quick financially based technical fix.
  • Let’s focus on bringing humanity back into healthcare once again.
  • Let’s eliminate existing barriers to true caring.

 


7 ideas for maximizing ACO potential

 

This HealthAffairs article looks at  what Accountable Care Organization funders can do to maximize an ACO’S potential. Among the suggestions of the authors, Andrea Ducas, Rob Houston, Tricia McGinnis, and Stephen Shortell:
1. “Encouraging movement toward greater accountability. Experts still grapple with the question of what ACOs are really accountable for. There is a need to clarify goals (for example, cost reduction, quality and value improvement, transfer of risk to providers) and to use these insights to drive accountability…. ”


2. “Breaking down policy and regulatory barriers
. Barriers exist that inhibit optimal ACO data sharing, such as privacy regulations, software interoperability, and regulations limiting how Medicaid funding can be used to address the social determinants of health. Minimizing these barriers may help ACOs and their partners to create more efficient and innovative ways to serve patients.”

3. “Facilitating multipayer alignment. Support for alignment—for example, aligning payment methodologies with quality measurement and reporting requirements, but also aligning efforts across payers and programs—may help ACOs develop more population-based models, reduce measurement confusion, and increase provider participation.”

4. “Refining risk adjustment across populations and services. More accurate risk adjustment methods that include factors like the social determinants of health could make ACOs better able to bear more financial risk and to support population-based models, particularly for people dependent on the safety net.”

5. “Managing market consolidation. Additional research is needed to determine the effects of ACO arrangements on market consolidation. The results from such research could inform future regulatory or other market action that may be taken by state or federal governments, if they felt it was warranted.”

6. “Encouraging greater patient engagement in care. Funding could be used for research or pilot projects to improve patient engagement. More specifically, foundations could explore ways that well-designed incentives might promote shared decision making and greater self-care management.”

7. “Improving measurement of ACO success. Randomized controlled trials and other formal, but more feasible, methods of evaluating ACO interventions and performance relative to non-ACO activity could help to identify key factors in ACO success and lead to adoption of more scalable models.”

 


Texas venture is aimed at improving population health

 

Baylor Scott & White Health and Tenet Healthcare, both based in Dallas, have a joint venture to own five Texas hospitals. The parties say the mission of the venture is to improve population health.

The  joint venture will own:

  • Centennial Medical Center (Frisco).
  • Doctors Hospital at White Rock Lake (Dallas).
  • Lake Pointe Medical Center (Rowlett).
  • Texas Regional Medical Center at Sunnyvale (Texas).
  • Baylor Scott & White Medical Center – Garland (Texas).

Becker’s Hospital Review reported that all the hospitals “will have Baylor Scott & White Health branding as early as this spring. Additionally, physicians, advanced practice providers and other employees of Tenet’s North Texas physician group will transition to Baylor Scott & White Health’s physician group HealthTexas Provider Network.”

Tenet Chairman and CEO Trevor Fetter said: “We have already made meaningful progress in advancing population health through our physicians’ participation in the Baylor Scott & White Quality Alliance, a leading local Accountable Care Organization, and the completion of this joint venture is an important next step in coordinating top-quality, value-based care in North Texas.”


Johns Hopkins system’s ACO problems

 

This article in Academic Medicine discusses the difficulties of an Accountable Care Organization formed by Johns Hopkins Medicine, some Washington, D.C.-Baltimore area hospitals and three medical practices.

One big problem was electronic health record systems that didn’t communicate with each other.

Other problems included trying to getting and analyzing claims data, governance issues and getting the full cooperation of providers.

The authors’ conclusions included this observation:

“Network strategies among AMCS {academic medical centers}, including adding community practices in a nonemployment model, will continue to require thoughtful strategic planning and a keen understanding of local context.”

 

 

 

 

 

 

 

 


2 big Ohio systems merging their ACOs

 

Two Ohio health systems will jointly contract for accountable care with health plans under a newly created clinically integrated network with broad geographic reach in the Buckeye State.

Cincinnati-based Mercy Health, formerly Catholic Health Partners, and Akron-based Summa Health said that each system’s Accountable Care Organization would join a new organization, Advanced Health Select — a clinically integrated network.

Other large regional systems, such as, in Michigan, Ascension Health and Trinity Health,  have been working to broaden their contracting in similar ways

The idea in the Ohio case is to build on ACOs’ success in the Medicare Shared Savings Program and the  systems’  total of  $100 million invested in the last four years in data analytics, information technology and care coordination.


Doctors should make their empathy more overt

compassion

This piece in Medscape argues:

“Doctors If you work in a hospital, an outpatient practice owned by a hospital, or an independent practice, or if you are a member of an Accountable Care Organization (ACO), training in how to empathically communicate with patients may be in your future. That’s because the traditional paradigm for good bedside manner—detached concern—is now being viewed by insurers, health plans, and hospital systems as being too detached, when surveys show that patients want more interpersonal connectedness with and trust in their physicians. ”

James A. Tulsky, M.D., chairman of the Department of Psychosocial Oncology and Palliative Care at the Dana­Farber Cancer Institute and chief of the Division of Palliative Medicine at Brigham and Women’s Hospital, in Boston, told Medscape that most physicians are  empathetic.

“I think that’s the reason they go into medicine. They care about other people.”

“The question, ” he says, is “whether patients know that their doctors are feeling that empathy, and whether doctors are able to express that to a patient in such a way that the patient feels supported. That’s the issue. The question is not about whether doctors lose empathy or whether one needs to unlock empathy.”

Benefits of a more patient-centric, visibly empathetic approach include: sharpening diagnostic skills, improving patient compliance — and  thus outcomes — higher job satisfaction and reduced chances of being sued for malpractice.

 

 

 

 


MIPS looms, but maybe you can opt out

 

Providers are girding their loins to comply not only  with the next stage of the Meaningful Use program, but also a  new mandated electronic reporting requirement: Medicare’s Merit-based Incentive Payment System (MIPS).

The MIPS combines parts of the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier, and Meaningful Use into one single program based on quality, resource use and clinical-practice improvement.

Robert Tennant, senior policy adviser with the Medical Group Management Association (MGMA),  told MedPage Today that the two programs are very inter-twined:
“Even though Meaningful Use was sunsetted, it’s now effectively 25% of your MIPS score, so it never really goes away.” And because it is so much of the MIPS score, “it’s potentially more impactful on your reimbursement.”

But Linda Delo, D.O., a family physician in Port Saint Lucie, Fla., told the online news service that, as MedPage paraphrased her, “{P]hysicians can get out from under MIPS in some cases if they become part of an alternative payment model such as an Accountable Care Organization (ACO), a bundled payment model, or a patient-centered medical home (PCMH), rather than continue in the traditional fee-for-service Medicare program.”

 


N.Y.-Presbyterian creating population-health division

cornell

New York-Presbyterian Healthcare System’s Weill Cornell campus, on the East River.

New York-Presbyterian Healthcare System  is creating a population-health division in part to aid the system’s planning for the huge healthcare changes underway and accelerating.

The population-health division will be within the delivery network, with a leadership team of two physicians at the top to “enable its continue success under its new model of integrated care,”  the system said.

New York-Presbyterian, which is linked with the Cornell and Columbia medical schools, has been moving in the population-health direction for some time. Initiatives have included its 13 patient-centered medical homes in its ambulatory-care network and a joint venture with the two medical schools to start a Medicare Shared Savings Program Accountable Care Organization earlier this year.

Now, apparently, the system has reached critical mass to have a  formal population-health unit.

The division will, among other things, boost its ability to analyze claims data and improve care-management skills. Officials are also looking into such things as boosting partnerships with retail health clinics and dramatically increasing the use of telemedicine.

The system thinks that three to five years will be needed to get the new population-health program up to  full speed.

 


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