Even as providers across the nation digest details of the federal government's shared savings program, it is apparent that the quest to create accountable care is well under way. Hospitals, doctors, insurers and even employers are forging new relationships in an effort to streamline and improve the care delivery system. The ultimate goal is to provide more efficient care, enhance the patient experience and control costs. Executives at Methodist Medical Center in Peoria, Ill., are banking that they can do all three of those things, and maybe more, for Caterpillar Inc. Methodist has teamed with Caterpillar, which is also based in Peoria, to develop a performance-based contract. H&HN Senior Editor Suzanna Hoppszallern spoke with Methodist Vice President and Chief Information Officer Steve Riney about the unique arrangement.
Tell me about the relationship with Caterpillar.
Methodist has a preferred provider agreement with Caterpillar through two insurance options, an HMO and PP0. Along with Caterpillar, we have developed a value-based, pay-for-performance agreement based on quality and patient satisfaction metrics.
What have you learned so far?
It's only been a year and half, but we've learned that we have to go out and work with our partners like Caterpillar. We have to know what they want and what they need. We need bring ideas to them and work collaboratively, so we can get to a point at which they are learning from us and we are learning from them. We want to be able to leverage that to other self-funded employers in our area and build on the experience.
How big of a factor is cost in the partnership with Caterpillar?
It's one factor. If you have low cost, but you don't have quality or patient satisfaction (or employee satisfaction at Caterpillar), you don't have much. If you have the best quality in the world and Caterpillar can't afford it, or the patients don't like it, you don't have much there. It's this triad of elements that has to be there. You have to have cost, satisfaction and quality.
Why would other self-funded firms be interested in this kind of model?
They are at risk. If you have typical insurance, the carrier is at risk. If there's too much care or costs are too high, the insurer will lose money. In our situation with Caterpillar, there is more motivation because if we save money in care delivery, the company gets those savings. As a self-funded employer, it is that kind of innovation and that kind of economic relationship that allows us to say, "OK, we can help you. We can help you to be a more efficient organization and more competitive globally."
What will it take to implement an ACO model? What technology is needed?
We have been focused on automation, especially across the continuum of care, for the past 10 years. We employ 160 physicians. We have a home health service and we have acute care services. We've automated those solutions and systems and are able to gather information through an enterprise-wide master patient index. We are able to get metrics and dashboards that have helped drive the quality improvement and efficiency gains.
We have to continue getting results in the areas we talked about — quality, efficiency, patient satisfaction. Because we've done so much on the automation front, those are things at which we are very strong already. We need additional technology to move further along though. There are a lot of analytics required to work with the data in our systems. The other piece is being able to get the claims data, not only the claims in our system, but also for any patient for whom we would be responsible in an ACO.
So metrics are key to analyzing the entire population in an ACO?
We're going to need that information to be an effective ACO. Ultimately, we need to talk about that word "accountable." We need to be accountable, but the patient also needs to be accountable for what is going on and we need to be able to see what's happening with the patient across the care continuum and across organizations.
One of the other things we are doing, on a trial basis, is adding independent community physicians to our electronic medical record. We only see their data when we care for their patients, they only see our data when they care for our patients. Ultimately, that kind of connection is going to be very helpful.
Is this a model for other providers and employers?
There's a lot of change in health care right now. There are bundled payments, pay for performance, and more. There's a lot of stuff out there. Will an ACO be the thing that sticks? We don't know, but we want to be on the front end because whatever we learn, we'll be able to leverage it into other things. We want to build partnerships and work with our employers to say, "We want to meet your needs. We want to help you be more efficient. We want to be able to provide better care to our patients, your employees."