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Money seems to triumph over an ACO’s good intentions


Creating Accountable Care Organizations is meant to improve care and help cut the costs of the world’s most expensive healthcare system. But such attempts run into a huge barrier caused by the fact that  U.S. physicians, who are used to making far more money than their equivalents in the rest of the world, and hospital executives strive to stick to the fee-for-service approach that has made them so affluent.

Consider Cornerstone Health Care, a large physician group in North Carolina, that made a big bet a few years ago when it turned itself into an ACO.

It seemed to work for a while. But then began an exodus of physicians seeking the more money they could get from working directly for hospitals.

As a New York Times story noted:

“Cornerstone’s experience illuminates just how tough it can be to overhaul the way medical care is delivered, even when the change is a priority for doctors and the government. As Cornerstone learned, hospitals and doctors frequently fight the changes, because they believe they can make the most money under a fee-for-service model.”

To read The Times’s piece, please hit this link.

In moving to value-based care, go all out


An article in Hospitals & Health Networks looks at  the effect of new  models implemented at Cornerstone Health Care, a multi-specialty physicians practice in North Carolina.

The group’s leaders   didn’t believe that the fee-for-service, sick-care-oriented model would remain viable in a rapidly changing market. So Cornerstone pivoted from volume- to value-based care across all lines of business.

“How? First, efforts were made to identify Cornerstone’s five highest-risk populations: late-stage congestive heart failure, oncology, Medicare-Medicaid dual-eligible patients, those with five or more chronic conditions, and complex patients with multiple late-stage chronic conditions. Then, rather than bolting on care management resources and services to existing practices, the group redesigned the care those patients received from the ground up.

“Cornerstone created five new comprehensive care models and restructured everything from staffing, care team roles, policies and procedures, and patient engagement methods to the physical layout of offices. Leadership determined that to best meet the needs of Cornerstone’s more complex and higher-risk populations, the group needed dedicated facilities, and so it built two entirely new clinics,” the H&HN article says.

“One year later, Cornerstone analyzed the results of the program. And the results were impressive:

  • “The transformation program as a whole yielded a nearly 13 percent decrease in total cost of care.
  • “Some programs achieved savings as high as 19 percent.
  • “Inpatient hospital costs were reduced by 30 percent.
  • “Some individual care programs reduced hospitalization by as much as 45 percent.

“The reduced inpatient costs were particularly significant, as they are a key to overall savings. Previously, inpatient costs accounted for 47 percent to 70 percent of total medical costs for these patients. In just one year, Cornerstone cut that by one-third.”

Cornerstone identified three key elements in the initiative’s success:

Partway isn’t enough: Small steps won’t work.

Design care from the patient up

Be willing to be disrupted and disrupting.

To read the piece, please hit this link.

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