In a presentation titled "Turning Today's PHO into Tomorrow's ACO," at Becker's Hospital Review Annual Meeting in Chicago, Elizabeth Simpkin, vice president of consulting services, and Carole Black, MD, chief medical officer of Valence Health discussed physician-owned hospitals, accountable care organizations and the future of the healthcare industry. They discussed two possible tracks for healthcare organizations in dealing with government payors: expanding managed care or creating an individual care delivery system. Both systems include monitoring costs and restricting eligibility.
"The area of most development and innovation is around what most commercial payors are doing," says Ms. Simpkin. "We think there is a lot of provider sponsored health plans out there that are getting more and more into this space as well."
The coming decision from the Supreme Court about the constitutionality of the Patient Protection and Affordable Care Act's individual mandate will make an impact on how future pooled risk programs are developed. "ACOs are the way forward," said Ms. Simpkin. "It's what is happening and could be our last best hope to change the cost trajectory in healthcare without draconian regulations placed upon us."
Ms. Black discussed the logistics of creating accountable care organizations in the future and encouraged providers to examine:
• Policies and procedures
• Shared agreements on how to work together for care delivery
• Data that will be used and how to collect the data
• Comparing individuals to peers for agreed-upon performance measures
• Creating registries for population management
• Reaching out to high-risk patients
"The key is how fast you do things in an evolutionary manner," said Ms. Black. "Really begin at the beginning; take the heaviest hits where the biggest opportunities are and evolve over time."
The presentation also addressed formal care coordination programs, which focus on the patients most in need. In these situations, Ms. Black said there must be a physician leader who can maintain provider efforts. "We need to have physician leaders," she said. "Choose a leader who is developable and decide how to develop them. It can be a leader among equals, someone who can inspire, someone who can be create, someone who is honest and someone who is fair and balanced. Get doctors who are engaged and interested as well as respected by their peers and make them medical director of your ACO."
She said it is likely the medical director will struggle, but ultimately be successful if given the right tools and support. The physician leader should have a mentor and stipend to depend on in their new role.
"All too often, an organization that exists has some baggage already so revisiting leadership is necessary," said Ms. Simpkin. "You have physicians who are wonderful and been a part of the organization for a long time, but they don't have any successors. You also need community and patient representation on the board."
Bringing in new physicians or patient advocates may be necessary to really get the work done.
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"The area of most development and innovation is around what most commercial payors are doing," says Ms. Simpkin. "We think there is a lot of provider sponsored health plans out there that are getting more and more into this space as well."
The coming decision from the Supreme Court about the constitutionality of the Patient Protection and Affordable Care Act's individual mandate will make an impact on how future pooled risk programs are developed. "ACOs are the way forward," said Ms. Simpkin. "It's what is happening and could be our last best hope to change the cost trajectory in healthcare without draconian regulations placed upon us."
Ms. Black discussed the logistics of creating accountable care organizations in the future and encouraged providers to examine:
• Policies and procedures
• Shared agreements on how to work together for care delivery
• Data that will be used and how to collect the data
• Comparing individuals to peers for agreed-upon performance measures
• Creating registries for population management
• Reaching out to high-risk patients
"The key is how fast you do things in an evolutionary manner," said Ms. Black. "Really begin at the beginning; take the heaviest hits where the biggest opportunities are and evolve over time."
The presentation also addressed formal care coordination programs, which focus on the patients most in need. In these situations, Ms. Black said there must be a physician leader who can maintain provider efforts. "We need to have physician leaders," she said. "Choose a leader who is developable and decide how to develop them. It can be a leader among equals, someone who can inspire, someone who can be create, someone who is honest and someone who is fair and balanced. Get doctors who are engaged and interested as well as respected by their peers and make them medical director of your ACO."
She said it is likely the medical director will struggle, but ultimately be successful if given the right tools and support. The physician leader should have a mentor and stipend to depend on in their new role.
"All too often, an organization that exists has some baggage already so revisiting leadership is necessary," said Ms. Simpkin. "You have physicians who are wonderful and been a part of the organization for a long time, but they don't have any successors. You also need community and patient representation on the board."
Bringing in new physicians or patient advocates may be necessary to really get the work done.
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