Cooperating for better care.

Richard Asinof

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ACO boundaries ‘not consistent with communities’


This fascinating interview in ConvergenceRI with  Louis Giancola, the CEO of South County Health, whose South County Hospital is Rhode Island’s remaining independent acute-care hospital, gives a very interesting overview of the challenges facing such institutions.
Among other things, he talked  with the news service’s editor, Richard Asinof, about how, in Mr. Asinof’s words, “the new models of Accountable Care Organizations and accountable entities with managed Medicaid programs were being developed in Rhode Island” in the new age of population health.

Mr. Giancola worried about how the  state’s population was going to be divided up:

“There are a million people in Rhode Island, and you’re going to carve the population up by ACOs, which is not consistent with communities, not geographically. It will be payer- specific, and it is going to cut across a lot of different communities.”

Redefining who’s at ‘risk’ in healthcare



Richard Asinof, writing for ConvergenceRI, discusses the redefinition of risk as lines blur between hospitals and insurers in Rhode Island and elsewhere.

He notes such developments as   “new Tufts Health Plan partnership with Lifespan to offer a tiered network health plan, known as Lifespan Premier Choice, beginning July 1, where the lowest-priced tier would all be providers within the Lifespan hospital system.”

And “CharterCARE Health Partners, the for-profit joint venture with California-based Prospect Medical Holdings and anchored by Roger Williams Medical Center and Our Lady of Fatima Hospital, is apparently recruiting physician groups in Rhode Island to join in a similar kind of narrow care network….”

Mr. Asinof notes that “the larger question, yet unanswered, pertains to how ‘health’ is defined within the healthcare delivery system and a continuum of care. Is health the absence of sickness as defined by the need for care? Is health defined by social and economic determinants beyond the measurement of the healthcare delivery system?

“As insurers become linked to hospital systems, and as hospital systems become their own insurance networks, and as the risk in the market is redefined as a doctor’s responsibility, how does the consumer play? What is the patient’s voice – other than to fill out a patient satisfaction survey? How do nurses – who hold up more than half the healthcare delivery system – get to play and be rewarded in the new value-based care reward system?”


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