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The Many Journeys to Accountable Care: 4 Case Studies

In a new report from Premier Research Institute for the Commonwealth Fund, the journey of four health systems is chronicled in their adoption and implementation of accountable care. The systems studied were:

  • AtlantiCare [New Jersey]
  • Fairview Health Services [Minnesota]
  • Memorial Healthcare System [Florida]
  • Presbyterian Healthcare Services [New Mexico]

The report looks at how each organization decided to pursue accountable care, assessing the internal environment, market characteristics, and payer mix. Also shared are implementation status, successful implementation strategies, and challenges faced by the systems.

Finally, policy implications are highlighted as well. Transition to accountable care requires an extensive investment, while the financial returns are not likely to be realized quickly.

Source: Damore JF and others, Premier Research Institute. The many journeys to accountable care: 4 case studies. Commonwealth Fund, Aug. 2013. http://www.commonwealthfund.org/Blog/2013/Aug/Many-Journeys-to-Accountable-Care.aspx and https://www.premierinc.com/wps/wcm/connect/2d3968e6-b532-491c-8ccf-2beb6ebfc7b8/Accountable+Care+White+Paper.pdf?MOD=AJPERES

Posted by AHA Resource Center (312) 422-2003, rc@aha.org

Value-Based Contracting for Hospitals

A new guide on value-based contracting is available to assist hospitals and health systems with the evolution of the nation’s health delivery system from a fee-for-service to a value-based payment model. The guide discusses the following:

  • Foundational requirements, including the need for shared goals and incentives, strong leadership and governance, and unified persistence
  • Assessment and preparation, covering desired position, service area, system infrastructure, resources, contract scope, types of arrangements and risks, capacity to carry risk, and the time frame for the transition
  • Financial and operational requirements, such as capital needs, unit costing/tracking, financial and actuarial assessment/planning, contracting capabilties, and data infrastructure
  • Evaluating a contract from the perspectives of responsibilities and risk, financial impact, and credit risk
  • Implementation success factors, encompassing physician engagement, transparency and accountability, and performance measurement and improvement

Other helfpul resources are also listed in the guide.

Source: Pizzo JJ and others of Kaufman, Hall and Associates. Value-based contracting. Signature leadership series. Health Research and Educational Trust/American Hospital Association, July 2013. http://www.hpoe.org/Reports-HPOE/Value-Based_Contracting_KaufHall_2013.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

HEALTH SYSTEMS: Optimum economy of scale $3-$5 billion+

The July issue of the Catholic Health Association’s journal, Health Progress, is largely devoted to articles about the changing role of Catholic health providers.  What does sponsorship mean today?  How can Catholic providers partner with secular and for-profit entities?  The Morrissey article contains an interesting factoid, which is a quote from an executive at Catholic Healthcare Partners, speaking about the advantages of health systems:

  • “We do believe in economies of scale; we think the optimum economy of scale is at least $3 to $5 billion in assets or annual revenues, and it might be larger than that.”  (page 8)

Source: Morrissey, J.  New partnerships for stronger mission.  Health Progress;94(4):7-13, July-Aug. 2013.  Click here: http://www.chausa.org/publications/health-progress/article/july-august-2013/new-partnerships-for-stronger-mission  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Top 10 biggest health systems: 2013 magazine survey

Each year, the magazine Modern Healthcare conducts a survey of the health systems in the US and compares them on the basis of net patient revenue and, in a separate table, by number of acute care hospitals.  The annual story provides a listing of the largest health systems and a more granular breakdown by whether the systems are public, for-profit, Catholic, non-Catholic religious, or secular.  There is also a listing of health systems operating home health agencies, for those with the largest number of home health visits.  The story discusses the degree to which health systems are getting involved in accountable care organizations (ACOs).  More data can be purchased from the publisher.  Note that health systems that did not participate in the survey are not included in the results.

Largest health system in 2013 (regardless of ownership type):  HCA (whether measured by revenue or by number of acute care hospitals)

Source: Evans, M.  Beyond ACOs.  Modern Healthcare;43(25):20-24, June 24, 2013.  Click here for publisher’s website: http://www.modernhealthcare.com/  More data can be purchased here: http://www.modernhealthcare.com/article/20130622/DATA/130629993/modern-healthcares-37th-annual-hospital-systems-survey Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

How many ACOs are there? 250 and counting

Here’s one just-published answer to the popular question: “How many accountable care organizations (ACOs) are there?”  These authors, with Weill Cornell Medical College in New York, state that there are currently more than 250 ACOs and that the number increased rapidly in 2012.  They anticipate that the number will continue to grow lickety-split not only due to federal government initiatives but because commercial insurers are signing ACO-like contracts with various entities.  The authors go on to discuss the meaning of population health (buzzword alert!) and what ACOs can realistically be expected to take on in that regard.

What do I like about this article?  It’s topical.  There’s a useful quotable number in it.  Even though it is not completely free full text online, the publisher will let you see the first page for free.

Source: Noble, D.J., and Casalino, L.P.  Can accountable care organizations improve population health? Should they try?  JAMA;309(11):1119-1120, Mar. 20, 2013.  Click here for the publisher’s website: http://jama.jamanetwork.com/article.aspx?articleid=1669825  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

Number of System-Affiliated vs Independent Community Hospitals, 1999-2011

System-affiliated hospitals outnumber those that remain independent. In 2011, 61% of community [acute care, non-federal] hospitals were affiliated with a health care system. This compares to 51% in 1999. Conversely, 39% of community hospitals were independent facilities in 2011, down from 49% in 1999.

Source: Table 2.1: Number of community hospitals, 1991-2011. In: Trendwatch Chartbook 2013, American Hospital Association, Feb. 26, 2013. http://www.aha.org/research/reports/tw/chartbook/2013/table2-1.pdf . Related chart 2.4 for 2001-2011: http://www.aha.org/research/reports/tw/chartbook/2013/chart2-4.pdf

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

POPULATION HEALTH: Catholic Health Initiatives’ pilot

Catholic Health Initiatives (Denver) http://www.catholichealthinit.org/, a large multi-institutional system, is working on managing population health based on the accountable care organization (ACO) model.  The target population is CHI employees.  The model is also structured on the medical home approach.  CHI hopes to cut employee health care costs by 10 to 14 percent. 

Why I like this article: At the end, there are suggestions on how other health systems might begin to approach population health management.

Source: Sanford, K.D.  Population health management: a “start small” strategy.  Healthcare Financial Management;67(1):44-47, Jan. 2013.  Click here for more information: http://insurancenewsnet.com/article.aspx?id=370913&type=newswires  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

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