Last month, leaders from Illinois-based Advocate Health Care gave hospital executives from across the country a glimpse into its 8-year-old, nationally recognized clinical integration program at a symposium just outside Chicago. I went to the event to interview Advocate's leadership team about its accountable care organization partnership with Blue Cross Blue Shield of Illinois and their potential participation in the CMS ACO initiative.
Beyond ACOs, though, Advocate's clinical integration program has several notable features, including a unique effort dating to 2004, to get its private insurers on board with a common set of quality measures and procedures used in its facilities and affiliated physician practices.
Usually, insurers want to rate hospitals on their own set of measures, not a set designed by a single hospital or health system, a point that Marty Manning, president of Advocate Physician Partners, acknowledged when I caught up with him. The key, Manning said, was regularly meeting with the insurers to make sure that Advocate's measures align with the payers' own areas of interest.
"We do formally meet with the payers every year to go over…what we have done well, where we have done not so well," Manning told me. "We try to keep those discussions very candid and honest, but also we ask what's important to them, what they see as emerging trends, and how can we work to better partner with them."
And Mark Shields, M.D., senior medical director for Advocate Physician Practices, said the system was able to convince its insurers that the use of a standard set of measures would engage and motivate physicians and other clinicians. That includes a clinical integration incentive fund for physicians and other employees, which grew from $12.4 million in distributed payouts in 2005 to $50 million last year.
"The main argument we've made is that by focusing the attention of our clinicians, we're able to move the dial, and then over time, we can add more measures," Shields said.
Currently, Advocate has 146 quality measures in place; the system started with 36 measures back in 2004.
Interestingly, while Advocate is still on the fence about whether to participate in the CMS ACO program as it forges ahead with its arrangement with Blue Cross Blue Shield, Shields was very bullish on the quality measures beginning to emerge from the federal initiative. While meeting all of the 65 quality measures in the first year of the program will be difficult for participants, Shields argued that the standards have value on their own as a measuring stick for providers, regardless of whether they formally participate.
"I think it's going to become the industry standard for measures," Shields said. "Out of those 65, having a subset of those can be a way to begin to move down the road of clinical integration. …We can quibble about individual measures, but certainly the general thrust is a very strong one."