3 ACO lessons from integrated systems

Integrated healthcare systems, with associated providers and health plans, have a leg up on implementing accountable care organizations to improve care and lower costs. Leaders from two Washington-based integrated systems shared some best practices and lessons learned for ACO success during a panel discussion Thursday at the AHIP Institute in Seattle.

They highlighted several key elements of ACO arrangements, including:

1. Aligned incentives

All of the panelists emphasized the fundamental need to align incentives. By doing so, payers and providers can make investments that avoid the cost of poor quality, said Matt Handley, M.D., medical director at Group Health Cooperative in Seattle.

But efforts must go beyond aligned incentives. Healthcare organizations must work to manage the ACO arrangements with new models of care and non-fee-for-service activities. "You can't do either/or," said Joseph M. Gifford, M.D., CEO of the Accountable Care Organization of Washington at Providence Health & Services.

That's why an ACO arrangement should build care delivery systems that coordinate care across the continuum and leverage and work with patients from both the health plan side and provider side. Within the ACO model, payers and providers can directly interact with the customer, directly face the market, and as a result, innovate approaches to care.

2. Partnerships

Gifford spoke of the difficult but important marriage of the health plan and delivery systems. "ACOs are about partnerships--with other individuals, others entities, other groups," he said. "Size matters and we still can't really do it alone," he added.

For example, for its ACO that serves a manufacturer, Providence has a variety of partners to coordinate care. While the partnership has its own rules of engagement, the entities are all equal partners at the table and make joint decisions, perform clinical integration activities and work together on pathways. "We are joined at the hip in order to serve mutual customers," he said.

Providence also partners with Banner Health in Phoenix, which is "highly evolved" in the ACO world, Gifford noted. That partnership lets Providence deliver a larger scope of ACO activities to customers with a bigger footprint and involves collaboration around best practices for direct care.

3. Shared decision-making

When implementing ACO arrangements, get patients informed and involved in healthcare decisions, advised Handley.

At Group Health, the pinnacle of its patient-centered accountable care is preference-based surgical conditions. The patient should decide the appropriateness of a hip replacement procedure, not the surgeon based on what the X-rays look like. It's the patient who has to make the tradeoffs between continuing to bear the difficulty of his or her symptoms with the risk and likelihood of good outcomes, Handley explained.

So Group Health uses video decision aids to foster a fundamentally different process in which patients take a more active role in deciding about their care, Handley said. This approach hasn't take off across ACOs because provider groups view it as a threat to revenue, given study results show patients with more information are less interested in surgical procedures.

But as an integrated healthcare organization, Group Health trained all of its surgeons, using role-play, to have different conversations with patients and distribute decision aids.

Shared decision-making helps ACOs achieve the triple aim. It improves outcomes, because the only people who get surgery are those who really want it. And it improves care experience, because the providers understand the patient's perspective. And both reduce costs.

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