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Why Accountable Care Matters: The C-Suite Perspective
|By Steven M. Safyer, M.D.||August 04, 2011|
A look at one hospital's 15-year journey to accountable care
Editor's Note: Steven M. Safyer, M.D., President and CEO of Montefiore Medical Center, is guest blogging today.
As an academic medical center with a truly integrated delivery system and a unique focus on its community, Montefiore Medical Center, the University Hospital for the Albert Einstein College of Medicine has been practicing accountable care long before the concept of the ACO was even developed.
Since 1996, Montefiore has partnered with several health plans to manage Medicaid, Medicare and commercial insurance for the care of 150,000 patients. As a result of this approach, Montefiore is pre-paid to provide the services required to care for a group of individuals. This aligns the incentives toward performance rather than transactions, resulting in patient-centered, high quality care with accountability.
Focusing on the health of our network of patients drives Montefiore to be proactive and innovative in the care it provides, working hard to focus on preventing health problems rather than just treating them. For high-risk patients in a specific population, our care management program has reduced the 30-day hospital readmission rate by 44 percent.
At Montefiore, we have carved our own path that has allowed us to provide excellent health care to a very poor community. For instance, one Montefiore patient, Sal Bowman, is 52 years old and suffers from diabetes, high blood pressure, and bad cholesterol. Because he is a member of our ACO, he receives comprehensive, ongoing education and support by a team of professionals that augment his relationship with his physician. His blood sugar levels are sent each day to his care management nurse, and if his levels get too high, he receives a phone call to determine whether he needs a particular medical intervention. At Montefiore, we can actually see how patients are doing block-by-block or doctor by doctor. This sort of specialized attention assures our patients receive truly outstanding care. I am confident this model can be replicated across the country.
A majority of physicians that practice at Montefiore are employed by Montefiore. They are incentivized to provide the latest best care based on the latest medical advances. Also, Montefiore has opened over 22 community-based comprehensive ambulatory care centers throughout the Bronx and Westchester, almost all of which are certified as patient-centered medical homes. This model requires we organize care around the patient in a coordinated team-based approach. We have launched 18 school-based practices that provide medical, mental health and dental services to students where they can best receive it, mobile vans and satellite primary care practices to provide care to those in need and scores of specialty care hubs throughout the region.
Our extensive use of information technology, both in the hospital as well as in the ambulatory practices, allows continued and prompt information across the provider network to manage the populations' health. This results in fewer unnecessary tests, procedures and hospitalizations. It also improves the patients experience, enhances the quality of care and lowers medical expense. Montefiore uses technology to increase provider engagement with their patients, not replace it.
The HMOs of the 1990s were all about managed price, not managed care. They rightfully earned the suspicion of patients and communities. It was not the narrowing of choice, but the emphasis on denial that deservedly drove away loyalty. For ACOs to succeed, the health care field must see that raising the quality of health care and containing costs are not inherently at odds; they just need to be in balance. That is the key to true health reform.
Steven M. Safyer, M..D, is the President and CEO of Montefiore Medical Center.
The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.