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Accountable Care Organization or Integrated Delivery System

Accountable Care Organization or Integrated Delivery System. Current Policy Diagnosis Fragmented fee-for-service system problematic Cost increases un-checked Quality uneven, un-measured Proposed Solution Structure integrated systems that can be measured, held accountable for care.

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Accountable Care Organization or Integrated Delivery System

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  1. Accountable Care Organization orIntegrated Delivery System • Current Policy Diagnosis • Fragmented fee-for-service system problematic • Cost increases un-checked • Quality uneven, un-measured • Proposed Solution • Structure integrated systems that can be measured, held accountable for care. • Have a structure to enable global or capitated payment. ACO.CoE 7.22.10

  2. What is an Accountable Care Organization or Integrated Delivery System? Large Multi- Specialty Group Very Large Medical Groups and Hospitals Small Group (1-5) Faculty Practice Plan Solo Practice Midsize Medical Group - Partners - Mayo - Inter- Mountain - Cleveland Clinic Kaiser V.A. Potential A.C.O.s

  3. Relationship of Accountable Care Organization To Payment Reform and Cost Control A.C.O. Large Group Organization Midsize Group Solo Practice Fee for Service Pay for Performance Bundled Payments Capitation Payment ACO.CoE 7.22.10

  4. Policy Conundrum Accountable to Who? Pros and Cons of Large Scale • Size and scale needed for • I.T. • Peer review • Building Culture • Capitation • Size and scale can lead to market power • Answers • Competing organizations or • Rate regulation ACO.CoE 7.22.10

  5. Reflections on Management Dana-Farber/ Partners Joint Venture Partners HealthCare System, Inc. Two Physicians Appointed by Partners Partners CommunityHealthCare, Inc. Newton- Wellesley Health Care System, Inc. Brigham And Women’s/ Faulkner Hospitals The Massachusetts General Hospital North Shore Medical Center, Inc. • Founded in 1994, shortly after the founding of Partners. • PCHI is the provider network for Partners. • Intentionally given entity status to assure MD voice and build trust Newton- Wellesley Hospital, Inc. The General Hospital Corporation The Brigham and Women’s Hospital, Inc. Faulkner Hospital, Inc. ACO.CoE 7.22.10

  6. Overview of Integrated System Management Challenge of Building a “Hybrid” System • Partners envisioned and structured as somewhere between a “union” and a “confederacy” • Key governance authority at center • History and tradition of significant institutional autonomy • Flows from history • “Merger of equals” structure • Tradition of strong physician/service chief role • Complexity of adding other hospital and physician network ACO.CoE 7.22.10

  7. Overview of Integrated System Management First Seven Years – “The Early Years” • Key governance issues settled • Final operating and capital budget authority established at Partners. • Integration of back office functions, critically including I.T. • Measured pace of clinical integration • Establishment of physician network (PCHI) and contracting authority. ACO.CoE 7.22.10

  8. Overview of Integrated System Management Next Seven Years – “Adolescence” • Emphasis on building the physiology of an integrated system as it might impact medical care. • I.T. and LMR as a key enabler • Operationalize clinical impact through “high performance medicine” focus. ACO.CoE 7.22.10

  9. High Performance Medicine • Build I.T. infrastructure and physician culture to • Achieve safety goals • Order entry with guidance • Discharge data • Measure and meet quality standard • Hgb A1C • Focus on chronic disease management • Heart failure program • Focus on cost and utilization management • Guide to most efficient price • Guide to most efficient imaging ACO.CoE 7.22.10

  10. Reflections on Management Issue of Scale: How do you run a 7 Billion Dollar Organization with over 50,000 Employees? • Build key leadership team • Continuously scan across enterprise • Dive down on key current issues ACO.CoE 7.22.10

  11. Reflections on Management Build Key Leadership Team • It’s all about the right people • Key leadership characteristics • Judgment/temperament • Experience • Intelligence • Communications • Working with others ACO.CoE 7.22.10

  12. Reflections on Management Continuously Scan Across Enterprise • Regular meetings with top reports – individually and as a group • Regularly up-dated top 10 list – example from 4th quarter 2009 • Budget Tracking • High Performance Medicine • Primary care re-design • Cost management group • Capital availability – rehab • Industry relations – conflict • Research management • Attorney General • State reform • National reform ACO.CoE 7.22.10

  13. Reflections on Management Dive Down on Current Issues • Length of stay management at MGH • Partners wide adoption of EMR ACO.CoE 7.22.10

  14. Reflections on Management Three Management Tools • Medical model of management • Spectrum of options to develop understanding and consensus • Focus on how to say no ACO.CoE 7.22.10

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