Moving to ACO

The Move to Accountable Care begins with the creation of state of the art medical or health homes.  Based on years of research at major integrated systems like Kaiser and Group Health Cooperative, the medical/health home is very different in structure, fully supported with unique roles and HIT, to create a new model of approaching the management of patient care and outcomes.   The creation of health homes is foundational but is only one  of the process and structure changes that allow an organization to manage both financial risk as well and more importantly, quality outcomes.No longer are leaders asked to tweek a system here or there or cut costs around the edges; this process change requires a wholesale refocusing on the metrics by which all entities are evaluated and compensated. 

Working with Clients to achieve structures to do this work is creative, challenging and culturally wrenching!  Everyone knows that culture trumps strategy. 

Clients need to embed in their cultures the recognition that is not an experiment or an option.  The change that is required is fundamental because the system is fundamentally unsustainable at its current cost and value (outcomes).  Patients will find that its not the options that are available to them that make quality but knowing that the right option for their health and lifestyle is available to them and will have an outcome that they expect.  These value changes are occurring and will be supported by payors whether our cultures accept them or not.  The key to success is to embrace the paradigm shift and begin the build, balancing the "now" with the future in terms of revenue stream.

Moving to Standard Work Elements in a Medical Home

I have found that the most compelling and simple tool in use for the change in moving a practice from medical practice to health home are the elements of standard work from Group Health Cooperative of Puget Sound.  These elements including call management and outreach work cell define core traits of a value based practice.  Clearly a more aggressive model than hospital clinic medicine or private practice offices these elements lead to a trade-off with unnecessary hospital use.  We are using this model with Community Health Centers as they expand their role from a medical and case management outpatient site to one that bridges the transitions with other providers and manages chronic disease.

The Standard Work Elements are available on line at Group Health's website.

If you believed what you hear in the news, you would think that all change in healthcare will cease with a negative supreme court decision.   And if you are leading a healthcare agency and believe that then you are being left behind.  There is radical change occurring from community clinics to hospitals to insurers.  Insurers testified last week before the Senate Finance Committee to the enormous progress their integrated and coordinated models are making in regions throughout country.

As providers attempt to find their niche, those that hoped their niche was in merging or being acquired are rapidly finding out that that is just the beginning. Others are creating unique and experimental partnerships.

I have had a remarkable journey led by a community clinic and partnering with hospitals to rethink the spaces in between them.  The joint responsibility for patient transitions, for navigation, for coaching patients is not only seen in the HIT expansion but in new care coordination roles and RN roles.  Joint venture approaches to afterhours and urgent care are exciting.  Joint efforts to avoid duplication of testing between hospitals based on shared quality standards could produce real savings.

The automation of risk triggers and patient monitoring will drive down unnecessary hospital visits for a significant population of chronically ill patients.  The model embraced by these partners is wholistic and flexible; focused on the strengths of the past and the opportunities to look at care differently and more broadly; less really is more!