Quality Center

Putting People First: Value-Driven Health Care

By Wes Champion

If you ask most people what quality health care looks like, they describe healthy people. But is the current system set up to deliver that result? Sadly, the answer is no. Today, incentives for health care providers are based on doing more procedures for patients—the more tests performed, illnesses treated and medications prescribed, the higher the reimbursement. Although the goal is improved health, providers are stuck with a system focused on sickness and not prevention. They are caught in a trap of yesterday's science and perverse incentives.

Accountable care organizations represent a way to transform health care delivery to address these concerns. ACOs connect providers who are willing to take responsibility for improving the health status, experience and efficiency of care for a defined population. In the ACO, people are partners working with caregivers to manage and improve their health. At the same time, ACOs shift the incentives so providers aren't rewarded for the volume of care provided to those that are sick; instead, they are paid based on their ability to keep people healthy.

Transforming health care in this way represents a significant challenge. That's why 19 of the nation's leading health systems representing 15 states and more than 70 hospitals have joined two ACO collaboratives. Working with the Premier health care alliance, participating health systems will create some of the earliest ACOs in the market, accepting accountability for more than 1.4 million patients and committing to lower costs by improving care coordination, efficiency, quality and satisfaction.

The collaborative will be based on executable solutions, rather than theories, to produce best practices for building nd managing a successful ACO. Participating ACOs will focus on real-world, tested best practices in areas such as:

•People-centered foundation to ensure engagement, activation, satisfaction and increased
self-accountability for health.
•Health homes that deliver primary care and coordinate with other providers as patients
move across the delivery system.
•New approaches to primary, specialty and hospital care to reward care coordination,
efficiency and optimized patient experiences.
•Population health data management to enhance the clinical and administrative aspects of care.
•ACO leadership, with management that overcomes fragmentation, including reimbursement
arrangements that incentivize improved outcomes.
•Payer partnerships based on deep operational interactions across a wide spectrum of services,
including predictive modeling, case management, medical management, financial reporting, etc.

The ACO collaboratives are designed to bring together all the elements needed to become high-performing health care systems. The carefully considered, tested and validated tools and processes that will be delivered will enable providers to proactively build, test and scale this new approach to health care.

Few would disagree that something must be done to rein in health care costs, expand access, promote wellness and improve quality. ACOs present an exciting and fundamental shift in health care—a change that will touch virtually everyone providing, receiving or funding care.

There's a saying that every system is perfectly designed to create the results it gets. When we pay for volume, we get volume. In shifting toward accountability, we can redesign care so that we pay for improved health in local communities. This is the real goal of health care reform – highest quality care at a more cost-effective price.

Wes Champion is senior vice president of Premier Consulting Solutions, a division of the Premier health care alliance. Visit www.hpoe.org to explore these and other topics.

This article 1st appeared in the July 2010 issue of HHN Magazine.

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