Katherine Schneider, MD, vice president of health engagement at AtlantiCare in Egg Harbor Township, N.J., discusses her health system's role in Premier's new Accountable Care Collaborative, announced in May. The health system consists of AtlantiCare Regional Medical Center, a 567-bed teaching hospital with campuses in Atlantic City and Pomona, N.J., and a variety of outpatient sites in southern New Jersey.
Question: What is the Premier collaborative?
Katherine Schneider: Nineteen health systems have joined together to help each other design and implement accountable care organizations in each system's service area. Premier chose these organizations because they have been early adopters. Each of them has the building blocks in place to start an ACO.
Q: Who are the other members?
KS: The collaborative also includes Aria Health in Philadelphia, Baystate Health in Springfield, Mass., Billings (Mont.) Clinic, Bon Secours St. Francis and Richmond Health Systems in North Carolina and Virginia, CaroMont Health in Gastonia, N.C., Fairview Health Services in Minneapolis, Geisinger Health System in Danville, Pa., Heartland Health in St. Joseph, Mo., North Shore-LIJ Health System on Long Island, Presbyterian Healthcare Services in Albuquerque, N.M., Saint Francis Health System in Tulsa, Okla., Southcoast Hospitals Group in Fall River, Mass., SSM Health Care in St. Louis, Summa Health System in Akron, Ohio, Texas Health Resources in Arlington, Texas, and University Hospitals in Cleveland.
Q: What issues are members of the collaborative exploring?
KS: There are nine work groups centered on various aspects of ACOs. They are:
1. People-centered foundations, which has to do with creating the ideal patient experience;
2. The health home, or patient-centered medical home;
3. The high-value network, using hospitals, nursing homes and specialists besides primary care physicians;
4. Payor partnerships and payment models;
5. Population health data management, involving IT systems that link ACO participants together;
6. Legal issues, such as risk of Stark and antitrust violations, which can occur when independent providers collaborate;
7. Measurements of effectiveness;
8. Public communication and advocacy; and
9. ACO leadership, which examines financing and contracting, such as bringing in physicians through a physician hospital organization and working with other providers.
Q: What innovative approach has AtlantiCare been working on?
KS: We have been developing a patient-centered medical home, which involves having a continuous relationship between the patient and provider. Our Special Care Center in Atlantic City has been in operation for three years. Participation is limited to people with chronic conditions. Everybody gets a "health coach," a medical assistant who has special training to help people overcome barriers to self-management.
The idea is to remove "the tyranny of the visit," which is the way healthcare is delivered now. In the current system, a practice only gets paid if the patient comes in for a visit, which is not conducive for ongoing management of chronic conditions. Getting paid in a different way, for ongoing care, meant we had to make a special arrangement with our employer-partners who paid for the care. The employer can pay a per member, per month fee, a kind of managed care capitation. Or the employer can pay in "shares," covering a percent of the budget of the Special Care Center.
You can’t change the delivery system without changing the payment system. Patients in the Special Care Center do not get charged a copay and the center doesn’t operate on billing codes. What would you put own as the billing code for spending two hours with the patient to keep her out of the hospital? Providers are not paid in RVUs, but in outcomes, which is very freeing because they have the opportunity to innovate. For example, the pharmacist and physician discuss strategy and decide to move the patient from one statin to another.
Q: What are the implications for your organization?
KS: The ACO is not a hospital-based activity, although a hospital is an important partner in it. This country still has a hospital-centric healthcare system. The changes that are coming up are turning that form of organization sideways. The question becomes, "How well are we doing out there in primary care land?" The hospital has to pivot. It has to go from being the center of the world to being a cost center.
Q: Are you committed to starting an ACO?
KS: Yes, we are committed. We started meeting internally on this in April, when we joined the premier collaborative. CMS is pushing the "shared savings" model, under which the ACO gets a bundled payment and distributes it among the participants, but there are all kinds of variations on this. This is an incredible opportunity to repair all the things that need to be fixed in our healthcare system.
Q: What happens next?
KS: Collaborative members will measure the success of their efforts by measuring overall health, patient satisfaction and the cost of care in their communities. In Jan. 2012, CMS will begin to take applications for ACO contracts. It's an exciting time to be in healthcare leadership. We have a chance to change the paradigm.
Learn more about AtlantiCare.
Learn more about Premier.
Question: What is the Premier collaborative?
Katherine Schneider: Nineteen health systems have joined together to help each other design and implement accountable care organizations in each system's service area. Premier chose these organizations because they have been early adopters. Each of them has the building blocks in place to start an ACO.
Q: Who are the other members?
KS: The collaborative also includes Aria Health in Philadelphia, Baystate Health in Springfield, Mass., Billings (Mont.) Clinic, Bon Secours St. Francis and Richmond Health Systems in North Carolina and Virginia, CaroMont Health in Gastonia, N.C., Fairview Health Services in Minneapolis, Geisinger Health System in Danville, Pa., Heartland Health in St. Joseph, Mo., North Shore-LIJ Health System on Long Island, Presbyterian Healthcare Services in Albuquerque, N.M., Saint Francis Health System in Tulsa, Okla., Southcoast Hospitals Group in Fall River, Mass., SSM Health Care in St. Louis, Summa Health System in Akron, Ohio, Texas Health Resources in Arlington, Texas, and University Hospitals in Cleveland.
Q: What issues are members of the collaborative exploring?
KS: There are nine work groups centered on various aspects of ACOs. They are:
1. People-centered foundations, which has to do with creating the ideal patient experience;
2. The health home, or patient-centered medical home;
3. The high-value network, using hospitals, nursing homes and specialists besides primary care physicians;
4. Payor partnerships and payment models;
5. Population health data management, involving IT systems that link ACO participants together;
6. Legal issues, such as risk of Stark and antitrust violations, which can occur when independent providers collaborate;
7. Measurements of effectiveness;
8. Public communication and advocacy; and
9. ACO leadership, which examines financing and contracting, such as bringing in physicians through a physician hospital organization and working with other providers.
Q: What innovative approach has AtlantiCare been working on?
KS: We have been developing a patient-centered medical home, which involves having a continuous relationship between the patient and provider. Our Special Care Center in Atlantic City has been in operation for three years. Participation is limited to people with chronic conditions. Everybody gets a "health coach," a medical assistant who has special training to help people overcome barriers to self-management.
The idea is to remove "the tyranny of the visit," which is the way healthcare is delivered now. In the current system, a practice only gets paid if the patient comes in for a visit, which is not conducive for ongoing management of chronic conditions. Getting paid in a different way, for ongoing care, meant we had to make a special arrangement with our employer-partners who paid for the care. The employer can pay a per member, per month fee, a kind of managed care capitation. Or the employer can pay in "shares," covering a percent of the budget of the Special Care Center.
You can’t change the delivery system without changing the payment system. Patients in the Special Care Center do not get charged a copay and the center doesn’t operate on billing codes. What would you put own as the billing code for spending two hours with the patient to keep her out of the hospital? Providers are not paid in RVUs, but in outcomes, which is very freeing because they have the opportunity to innovate. For example, the pharmacist and physician discuss strategy and decide to move the patient from one statin to another.
Q: What are the implications for your organization?
KS: The ACO is not a hospital-based activity, although a hospital is an important partner in it. This country still has a hospital-centric healthcare system. The changes that are coming up are turning that form of organization sideways. The question becomes, "How well are we doing out there in primary care land?" The hospital has to pivot. It has to go from being the center of the world to being a cost center.
Q: Are you committed to starting an ACO?
KS: Yes, we are committed. We started meeting internally on this in April, when we joined the premier collaborative. CMS is pushing the "shared savings" model, under which the ACO gets a bundled payment and distributes it among the participants, but there are all kinds of variations on this. This is an incredible opportunity to repair all the things that need to be fixed in our healthcare system.
Q: What happens next?
KS: Collaborative members will measure the success of their efforts by measuring overall health, patient satisfaction and the cost of care in their communities. In Jan. 2012, CMS will begin to take applications for ACO contracts. It's an exciting time to be in healthcare leadership. We have a chance to change the paradigm.
Learn more about AtlantiCare.
Learn more about Premier.