Oakwood Healthcare, a four-hospital system in Dearborn, Mich., announced in June it was starting an accountable care organization. Here, Bill Isenstein, senior vice president for managed care at Oakwood, explains its plans for an ACO.
Q: What have you done so far to plan for an ACO?
Bill Isenstein: We have formed an advisory committee made up of five representatives of senor management, including myself, and 25 physicians, representing about 1,300 physicians on staff at our four hospitals. The committee has met once and will be meeting monthly from now on. We also want to set up site visits across the country to look at ACOs and related organizations under development.
Q: When will you have an ACO up and running?
BI: That depends on a lot of factors, not the least of which is getting a clearer idea of what the healthcare reform law wants to do with ACOs. While 19 sections of the law allude to ACOs, only one section names them explicitly. That's not that much detail. We are waiting for the government to issue proposed rules, which may come in the fall. In the meantime, it's a great opportunity to sit down with our physicians and figure how we can work more closely together.
Q: What are the first steps in the process?
BI: The first step is to get educated about ACOs, to get people on the same wavelength. It’s clear that there are going to be changes, so we need to start a dialog. We might want to form a physician hospital organization as the first step. Oakwood Healthcare had a PHO many years ago but it was disbanded. The new organization would probably be quite different from that. We need to ask: How do we govern this organization? How do we get people engaged? We need to think outside the box.
Q: Two competitors of yours, Henry Ford and St. John Providence, are also planning ACOs. Are private payors in Michigan going to be offering bundled payments for ACOs?
BI: Not that I know of. There may be some special payment arrangements for PHOs, but that would be very specific.
Q: How would your ACO distribute bundled payments for services?
BI: We may apply for a bundled payment pilot project, which would become available under healthcare reform. This might involve starting with orthopedic or cardiac procedures and taking it from there. For bundled payments to work, we would need to have some really frank discussions with physicians on how you divvy up the total dollars. Who distributes the money might be a contentious issue, but we believe we have a very loyal medical staff.
Q: Besides physicians, would your ACO bring in other types of providers?
BI: Oakwood Healthcare already has affiliations with nursing homes, rehab hospitals and other potential elements of the ACO. No one system can provide all the care, but the goal is to have all the providers in sync.
Q: Do you have IT connections, which would be necessary for an ACO?
BT: Our hospitals already have an EMR system and we have been offering a version of it to physicians on staff. A month ago Oakwood rolled out a second EMR product with a different look and feel for physicians to use.
Learn more about Oakwood Healthcare.
Q: What have you done so far to plan for an ACO?
Bill Isenstein: We have formed an advisory committee made up of five representatives of senor management, including myself, and 25 physicians, representing about 1,300 physicians on staff at our four hospitals. The committee has met once and will be meeting monthly from now on. We also want to set up site visits across the country to look at ACOs and related organizations under development.
Q: When will you have an ACO up and running?
BI: That depends on a lot of factors, not the least of which is getting a clearer idea of what the healthcare reform law wants to do with ACOs. While 19 sections of the law allude to ACOs, only one section names them explicitly. That's not that much detail. We are waiting for the government to issue proposed rules, which may come in the fall. In the meantime, it's a great opportunity to sit down with our physicians and figure how we can work more closely together.
Q: What are the first steps in the process?
BI: The first step is to get educated about ACOs, to get people on the same wavelength. It’s clear that there are going to be changes, so we need to start a dialog. We might want to form a physician hospital organization as the first step. Oakwood Healthcare had a PHO many years ago but it was disbanded. The new organization would probably be quite different from that. We need to ask: How do we govern this organization? How do we get people engaged? We need to think outside the box.
Q: Two competitors of yours, Henry Ford and St. John Providence, are also planning ACOs. Are private payors in Michigan going to be offering bundled payments for ACOs?
BI: Not that I know of. There may be some special payment arrangements for PHOs, but that would be very specific.
Q: How would your ACO distribute bundled payments for services?
BI: We may apply for a bundled payment pilot project, which would become available under healthcare reform. This might involve starting with orthopedic or cardiac procedures and taking it from there. For bundled payments to work, we would need to have some really frank discussions with physicians on how you divvy up the total dollars. Who distributes the money might be a contentious issue, but we believe we have a very loyal medical staff.
Q: Besides physicians, would your ACO bring in other types of providers?
BI: Oakwood Healthcare already has affiliations with nursing homes, rehab hospitals and other potential elements of the ACO. No one system can provide all the care, but the goal is to have all the providers in sync.
Q: Do you have IT connections, which would be necessary for an ACO?
BT: Our hospitals already have an EMR system and we have been offering a version of it to physicians on staff. A month ago Oakwood rolled out a second EMR product with a different look and feel for physicians to use.
Learn more about Oakwood Healthcare.