6 core components of Premier's accountable care collaboratives

Although accountable care organizations (ACO) are in the early stages of implementation, healthcare organizations can learn from the experience of integrated care superstars--Intermountain, Kaiser Permanente, Geisinger, Marshfield Clinic--that deliver lower cost, high-quality, coordinated care that engages the patient and delivers high satisfaction, according to Premier healthcare alliance Vice President Joseph F. Damore.

Premier is doing just that: creating a learning environment that supports more than 95 health systems which represent 450 hospitals that have joined its accountable care collaboratives.

Although these organizations are at varied stages of development, some already have embedded collaborative, accountable care into Medicare Shared Savings or Pioneer ACO models, commercial health plans, and Medicaid.

"The collaboratives are part of Premier's strategy to help transform healthcare across America and generate high-quality, cost-effective care," Damore said.

As part of this learning initiative, Premier operates two collaboratives. Its readiness collaborative includes nearly 70 health systems that work to master accountable care concepts and assess current capabilities. A second group, called the implementation collaborative, includes 28 health systems that support ACO concepts, rapidly moving to achieve collaborative, accountable care goals.

What is the process like? Damore and his three-person team assess how ready the organizations are for accountable care models. The assessment incorporates a research, self-assessment, and a two-day site visit.  The pre-site visit research examines the community, market and organization, financial and quality data, population-based information from sources, such as the Dartmouth Atlas, and national public health data by county.

Premier then asks each organization to submit information on its strategic direction, followed by a self-survey of 154 operating activities built around six core components: people, home health, high-value network, population health data management, leadership, and payer partnership.

On the first day of the visit, the morning is filled with education on accountable care principles and news, followed by discussions on collaborative goals, organization, population, market data, and then a session with the executive team. The second part details organizational scores and best practices for the 154 operating activities "to help organizations gain knowledge and move ahead at a rapid pace," according to Damore.

A second day includes physicians, offering them insight into the need for a physician leadership and hospital partnership, as well as distribution of a draft report for executives.

Premier then follows up with the organization with ongoing print and online education on topics, such as electronic medical records and population health, with face-to-face meetings for sharing and education.

To assess readiness for an accountable care model, consider the following six core elements:

1. People-centered foundation: People--anyone within the community that could be served by a provider--are surrounded by a continuum of care that includes pharmacy, long-term care, ancillaries, hospitals, hospice, and public health agencies. "We must be people centered and create a continuum of care connected to a specific individual," Damore said.

2. Home health: Called more comprehensive than the well-known patient-centered medical home, Premier's home health program promotes individual wellness through a team-based approach to care, with professionals such as nurse practitioners, nutritionists, and medical social workers.

Participation rates vary. Central Maine Medical Center in Lewiston, Maine, a member of Premier's readiness collaborative, has more than 20 primary care practices certified with a medical-home distinction, while St. Vincent Healthcare in Billings, Mont., has only two pilot health homes.

3. High-value network: Using a model developed at the Institute for Healthcare Improvement, called the "Triple Aim," members of the Premier collaborative use multiple tools to measure cost, quality, patient engagement, and satisfaction across the continuum of care. The Center for Medicare & Medicaid Services already has adopted Triple Aim and embedded it into the draft accountable rules, said Damore.

4. Population health data management: Electronic measurement systems allow Premier members to manage the health of a specific population. For example, out of a population of 10,000 employees, every diabetic is placed on a diabetic treatment protocol. Premier champions a disease-specific clinical pathway, which means that newly identified diabetics are automatically enrolled in a diabetes disease management program.

"If you manage diabetes preventively and on an outpatient basis you can prevent hospitalizations," Damore said. "And can give patients a higher quality of life at lower costs."

Premier also integrates patient satisfaction and engagement data into its database, evaluating the degree to which a patient is involved in care plan selection, input, and follow-through through a patient activation measurement score.

5. ACO leadership: "You must have physicians who are philosophically committed to your direction and willing to demonstrate leadership and education with other physicians in the accountable care community," Damore said.

Equally important are financial, administration, human resources, and IT leaders who are capable of "transforming from a hospital-centric culture to a population-based culture," he added.

6. Payer partnership: Health plans are the only organizations with claims, cost data, and quality measures based on claims data for an entire community or population. That's why a growing number of Premier members have partnered with health plans (Blue Cross, Aetna, and Cigna) to gain transparent access to information. Minneapolis-based Fairview Health Services, for example, has three health plan contracts featuring embedded accountable care principles and payment mechanisms.

Damore predicts that the collaboratives will grow and organizations will mature so that, three to five years from now, they will contract with multiple health plans based on accountable care principles and participation in Shared Savings. 

"The overwhelming majority of the 100 health systems in our collaboratives are fully engaged in moving this process forward and implementing accountable care principles in a manner and with speed that makes sense for the organization and community," Damore said.

-- Special contribution by Joyce Flory. For more on ACOs, check out our free eBook: "ACOs: The game-changing lessons that payers & providers have already learned."