The necessity of transformational change within the health care sector is now a matter of general consensus, regardless of whether elements of the 2010 reform legislation are repealed. While our nation continues to be the world's gold standard for health care quality, the health status of our population continues to be unacceptably low compared with peer nations. We have unacceptable disparities in coverage, and our costs per capita continue to rise, stifling our struggling economy and resulting in 17 percent of our gross national product and climbing.

Norton Healthcare has committed to a change agenda and believes putting the patient first is the best way to prepare our organization for financial success and stability and to serve our community. In 2009, Norton Healthcare and Humana began working with the Brookings-Dartmouth Accountable Care Organization pilot. The intent of initial participants was to explore new payment methodologies to bend the cost curve for health care. This journey was built on the strengths of our organization and tied strongly to our historical transparency with clinical quality and safety metrics, a focus on performance measurement, physician alignment, expanding health information technology infrastructure and advancing new models for the continuum of care.

Our initial focus included the employees of Norton Healthcare and Humana. The goal was not to transform our organization into an ACO, but to enable greater accountability for care. Norton Healthcare and Humana spent many months working through the legal and data requirements to establish benchmarks for improvement and identify areas for success. Norton and Humana signed a letter of intent in August 2010 and began benchmark measurements.

This experience toward accountable care has not been without challenges. Each of us provides patient care in unique environments with multiple financial and competitive pressures. Establishing alignment among physicians, hospitals and patients to improve care requires significant resources and relationships. As we approach the second year of our participation in the pilot, we have seen improvement in clinical quality indicators and slowed the progression of growth in health care costs for our attributed population.

The lessons learned are what makes the journey worthwhile. We found that the transformation to accountable care comes back to the basics:

Information. Each of our organizations is filled with data, but the true value comes from turning data into usable information for action.

People. The value of employees, patients and physicians to accept and manage change should not be underestimated.

Partnerships. Truly bending the cost curve will require modification to the current continuum of care. Future relationships require accountable and innovative partners to provide pre- and post-acute care.

The sum of these lessons will determine our future success. We believe a structure of accountability is an imperative for success, but also feel that changing methodologies to reimbursement structures will require an organization to be nimble and quickly adapt to change. It is a privilege to provide patient care and a responsibility to do so in a high-quality, cost-effective manner.

The health care field has never faced a more necessary or daunting requirement for transformational change. And we've never had such resources to facilitate those changes. Operating more efficiently under the current volume-based payment system while preparing for transition to a risk-based system will be our collective agenda for the remainder of this decade.

Steven Hester, M.D., is senior vice president and chief medical officer of Norton Healthcare in Louisville, Ky.

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