ADVANCE for Executive Insight 1 ADVANCE for Executive Insight

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CEO perspective While many provider groups have decided to wait until the “right time” to move away from fee-for-service and into the world of value-based care, other entities are moving swiftly into this unchartered territory. board and excited about this process. On the Web Visit our comprehensive ACO resource center, including news, articles and multimedia. Go to www.advanceweb.com/ executiveinsight and click on ACOs under “Resource Centers.” Moving Quickly into Action While BPN had some experience in quality improvement and cost containment through shared savings models and a Medicaid HMO, the transformation to an early adopter ACO was a significant step. No amount of strategic planning could completely prepare us for the changes ahead. Fortunately, our board believed that this transition was inevitable and was very supportive of our efforts to take a leap of faith into this unchartered territory. As your organization considers its approach, there will likely be a great deal of planning, financial modeling and analysis. While this is a crucial step, many organizations may become stuck in this phase and unwilling to proceed into an uncertain environment. That’s why it is essential to quickly move from the phase of contemplating change to actually being willing to take action, whether it is through a small pilot program or a full ACO model. Building a Technology Infrastructure To get to a true jumping-off point, organizations should transition to a shared technology platform that supports a team-based approach to care as well as improved clinical decision-making. At BPN and MPAC, we chose a global solution that could support all of our needs for clinical analytics, financial analytics, referrals, authorizations, customized reporting and patient/provider portals. Without this flexible and robust system, we could not have successfully transformed our business processes to achieve the triple aim of health reform — better care, reduced costs and an enhanced patient experience. By connecting physicians with meaningful insight at the point of care, including targeted patient data and evidence-based clinical practices, we empowered providers to improve outcomes. At the population level, this system also offered real-time data that allowed us to develop targeted care management and patient engagement strategies. Offsetting Investments Through Strategic Partnerships Many organizations may struggle with the resources and financial investments necessary to make accountable care a reality. Fortunately, strategies can help offset these investments. Many payers are motivated to partner with providers to build the infrastructure needed to support quality-based improvements. For example, BPN initially explored a shared savings model through a payer partnership before moving into a full ACO model. This allowed us to begin exploring the realm of value-based care while benefiting from financial incentives and support. My career has included leadership roles in both the payer and provider sides of the industry. I strongly believe that the success of these new models will depend heavily on whether these parties can come to the table to develop strategies that improve patient care and better manage costs while maintaining mutual profitability. The Time for Change is Now Based on my experience, there is no perfect time to pursue accountable care. If leaders and clinicians are willing to make the transition, there is no reason to delay the process. In fact, organizations that take bold steps toward value-based care today will be rewarded with growth opportunities and the ability to have a seat at the table with other innovative market leaders that are crafting the future of healthcare delivery. 18 ADVANCE for Executive Insight
cOo perspective Organizational Efficiencies of ACOs Expected—and unexpected—outcomes are revealed. By Robert Fortini, RN, PNP, and Richard Hodach, MD, MPH, PhD For traditional health systems and physician groups, embracing the Accountable Care Organization (ACO) model is no easy matter. After decades under fee-for-service, the ACO’s approach to profiting through shared savings requires traditional institutions to perform a 180-degree turn in mindset and practice. Even with a strong commitment to the ACO goals of higher quality, lower costs and greater patient satisfaction, it’s still a tough slog. With that in mind, it’s worthwhile to ask of those who have succeeded with an ACO, “Has it been worth the effort? Have you achieved the promised efficiencies? Have the changes enabled stronger collaboration among healthcare stakeholders? Were there unexpected benefits?” ACO Entrance Bon Secours Virginia Medical Group was a relatively early entrant into the ACO market. A participant in the Medicare Shared Savings Program, the hospital-owned, multi-specialty group practice with more than 400 providers across metropolitan Richmond, Va., inked value-based contracts with CIGNA and Anthem in 2012. CIGNA gives Bon Secours a per-member per-month (PMPM) adjustment for care coordination. Anthem pays a care coordination Are You Keeping Up to Date on ICD-10? Executive Insight and 3M have teamed up to bring you the latest ICD-10 updates in one convenient location. Check out our online resource center now to find: The new ICD-10 Resource Center has everything you need to stay informed. Strategies and Solutions for Healthcare Leaders BROUGHT TO YOU BY ■ News bulletins ■ Insightful articles ■ Clear-cut analysis ■ Multimedia ■ Webinars ■ White papers ■ Educational resources ■ And more Visit www.advanceweb.com/ExecutiveInsightICD10w.advanceweb.com/ExecutiveInsigh Check back regularly because we’ll be adding new features leading all the way up to October 1 and beyond. ADVANCE for Executive Insight 19
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