Early Results, Challenges among Diverse ACOs Documented in New Analysis

Industry-wide implications for policymakers, payers and providers also highlighted in white paper

Early Results, Challenges among Diverse ACOs Documented in New Analysis

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Some of the first examples of quality, cost, patient experience and utilization improvements among the nation’s earliest accountable care organizations (ACOs) are included in an analysis released today.

aPremier Research Institute™ white paper supported by The Commonwealth Fund, is a firsthand look into the experiences of a diverse group of health systems developing ACOs. It chronicles challenges these early adopters of accountable care were – and weren’t – able to overcome, their lessons learned, and the implications of their work for policymakers, commercial payers and other providers.

Successes, which primarily cover ACO contracts with payers in the private sector, include (through 2011):

“The Special Care Center has allowed us to have a real-time working laboratory for population health initiatives,” said Steven Blumberg, senior vice president and executive director, AtlantiCare Health Solutions. “This has created the culture and results required as we now expand these programs through our ACO into the rest of the organization.”

A shows prices for personal consumption expenditures on healthcare goods and services rose at the slowest rate in nearly 50 years. Additional suggests that, though the recession and other economic factors played a role in this decline, so did the implementation of new models of care delivery such as value-based purchasing and ACOs.

“As more providers move toward accountable care, it's vital to understand capabilities needed to create and participate in an effective model that improves quality while constraining healthcare costs,” said co-author R. Wesley Champion, senior vice president of Premier Performance Partners. “There’s no better way to learn than from firsthand experiences of these innovative health systems that have taken steps to become ACOs.”

All four organizations identified determining the ideal speed at which to implement accountable care as one of the most challenging aspects of transformation, according to co- author Joseph F. Damore, M.H.A., F.A.C.H.E., Premier’s vice president of population health management.

Fairview chose to move rapidly over the course of one year to minimize the time straddling fee-for-service and ACO payment models. Presbyterian Healthcare Services decided to move a bit less quickly, while AtlantiCare and Memorial Healthcare System chose to move more methodically over the course of several years, using pilots to prepare for spread. These choices reflect the variation in population health capabilities among these organizations.

“While we started earlier than some, Fairview’s healthcare transformation journey is far from over,” says Patrick Herson, MD, senior executive medical director of Fairview Medical Group. “We’re proud of the results we achieved so far to deliver exceptional clinical quality and experience to our patients at a lower total cost of care. As we continue to refine our data analytics capabilities and care processes, we’re confident we’re going to continue to deliver greater value to those we serve.”

According to Jessica Lerner, executive director at Memorial Healthcare System, “It was important for us to assess our population and understand what strategy would work for the people we serve. As a result of participating in this project, we learned that by improving redundancies in care, among other tactics, we are positively impacting results.”

Additional challenges:

Recognizing the strides the health systems made, several issues still need to be addressed:

“These four health systems are blazing the trail by being among the first in the nation to move forward with accountable care,” said co-author Susan DeVore, Premier’s president and CEO. “Their lessons learned can produce valuable evidence that will show others what works – and what doesn’t. Most importantly, their work will help them provide higher quality, more efficient care to the populations they serve.”

is the third of three Premier Research Institute white papers documenting ACO development. The , the . The studies are based on information obtained from interviews conducted in October and November 2011, and subsequent follow-up discussions, materials provided by the health systems and publicly available information.

The is a not-for-profit research foundation created by the Premier healthcare alliance. It conducts research using data collected from Premier members and leverages Premier’s experience for the improvement of healthcare globally. The institute’s research focuses on identifying the strategies and products that improve patient and community health and reduce costs. As a 501(c)(3) charitable organization, the institute funds its work through government foundation and corporate grants.

Premier is one of the nation’s largest performance improvement alliances of approximately 2,900 U.S. community hospitals and 100,000 alternate sites using the power of collaboration and technology to lead the transformation to coordinated, high-quality, cost-effective care. Owned by healthcare providers, Premier operates a leading purchasing network that provided members more than $5 billion in savings in FY2012. Premier also maintains clinical, financial and outcomes databases based on 1 in every 4 U.S. patient discharges. A world leader in measurably improving patient care, Premier has one of the largest performance improvement collaboratives in America, including one in partnership with the Centers for Medicare & Medicaid Services. Headquartered in Charlotte, N.C., Premier also has an office in Washington. .

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