Early ACO results: First steps prove challenging

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Early ACO results: First steps prove challenging

by Diana Bradley, Staff Writer | August 08, 2013

Analysis showed Presbyterian Healthcare Services reduced average length-of-stay and operating room volume for procedures formerly in the top utilization statistics. In addition, Presbyterian improved care management and reduced costs via reporting and oversight encompassing the entire episode of care.

Hospital admissions and emergency department visits were reduced by 40 percent by AtlantiCare, who also cut per member per month insurance costs by $174-$200 for its own employees and large payer groups through its Special Care Center by better managing patients with chronic conditions. Further, AtlantiCare achieved a two-fold patient satisfaction increase, according to the paper.

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The white paper shed light on the fact these four organizations are tackling payment reform and delivery system reform head-on and in parallel, according to Dr. Anne-Marie Audet, vice president of Health System Quality & Efficiency for the Commonwealth Fund.

"These are key ingredients to success," she said during Tuesday's webinar. "...We can't wait for payment reform to change the delivery system and we can't wait for the delivery system to change to figure out how we are going to pay for value."

Challenges
In the paper, all four organizations identified working successfully with providers and payers, a delayed return on investment and determining the ideal speed at which to implement accountable care as the most challenging aspects of transformation. Current state and federal regulations regarding the storing, sharing, and use of patient-related data were barriers to swift development of population health management capabilities.

Implementation speed was a particular challenge for Fairview, which chose to move rapidly over the course of one year to minimize time straddling the fee-for-service and ACO payment models, noted Dr. Patrick Herson, the organization's senior executive medical director during the webinar.

"A key challenge was aligning clinical and population health models with our payer and business models," he said. "The speed of how quickly you can move an organization our size can also be challenging."

For example, Fairview had a corporate graphic called the "messy yellow box", placing the organization between two operating systems: business and clinical models. Some people might be exiting the messy yellow box with their work, while others enter from another part of the organization. This results in a mix of people sandwiched together in a variety of different emotional, business and alternative operational spaces at the same time.

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