THE ACO VISION FACTORS FOR SUCCESS€¦ · Holly Michaels Fisher Vice President David W. Plocher,...

SPARKING CONVERSATIONS IN HEALTH CARE Summer 2011

HEALTH I.T. FRAMEWORK FOR REFORM

AGE OF ACCOUNTABILITY

LESSONS FROM CMS

THE ACO VISION FACTORS FOR SUCCESS

ignite.optuminsight.com

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A New Beginning

Summer 2011ignite.optuminsight.com

OPTUMINSIGHTJohn G. Nackel, PhD, FACHE CEO, OptumInsight, Consulting Executive Publisher

Lisa Meyer Executive Editor

Stephanie Vazquez Editorial Assistant

OPTUMINSIGHT EDITORIAL BOARDEric Cahow Senior Director

Dan Dunn, PhD Senior Vice President

Pamela Friedmen Vice President

Michael Goran, MD Managing Director

David Hochheiser Vice President

Joel Hoffman, ASA, MAAA, FCA Senior Managing Director

Scott Howell, MD National Senior Medical Director

Dan Kinsella Managing Director

Anne McCune, FACHE Managing Director

Holly Michaels Fisher Vice President

David W. Plocher, MD Vice President

Stephen Wood Managing Director

IMAGINATION EDITORIAL TEAMAccount Director Rachel Brooks

Editorial Director Sarah Stone Wunder

Editor Katherine Osos

Director of Operations & Production Heather Slattery

Production Manager Allison Bratnick

Design Director Doug Kelly

Senior Art Director Tiffany Mehnert

Contributing Writers Douglas Clark Kim Ribbink Andrew Schwartz

“”

We are aligning our health care services to provide greater understanding and access to our company’s full range of capabilities

F

http://ignite.optuminsight.com


ignite.optuminsight.com | IGNITE 1

WHAT’S NEXT FOR ACOsRealizing the bene!ts of accountable care depends on gaining buy-in from all stakeholders.

THE POWER OF HEALTH I.T.The push for ACOs demands a renewed focus on health information infrastructure.

CMS SPARKS A MOVEMENTCMS’ regulations will pave the way toward a new model of coordinated care.

Online Exclusives ignite.optuminsight.com

INSIDEQ&ATwo proponents of coordinated care offer their thoughts on a new model.

PERSPECTIVESJohn Nackel, CEO, OptumInsight, Consulting, explains how the CMS regulations open the door to reform.

PODCASTListen to the full interview with Anthony Shih of The Commonwealth Fund.

WEB EXCLUSIVELearn more about accountable care at our ACO portal: optuminsight.com/accountable-care-organization.

FEATURES4

1016

Q RSRT

DEPARTMENTS

2

20

STATES WITH THE MOST ACOs:DATA POINTSWhere are ACOs most prevalent?

Learn more in the Data Points section of ignite.optuminsight.com.

28% Northeast

Source: OptumInsight

29% Central

23% W-Central

20% E-Central

SUMMER 2011

CALIFORNIA - 10

WASHINGTON - 7

TEXAS - 7

OHIO - 6

MASSACHUSETTS - 6

NEW HAMPSHIRE - 6

NEW YORK - 6

WISCONSIN – 5

ACOs BY REGION

http://optuminsight.com/accountable-care-organization




2 IGNITE | Summer 2011

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^̂

>>

We view that continuum of care as much broader than just what happens during the medical experience.

Stephen Rosenthal, president and CEO of CMO, The Care Management Company of Monte!ore Medical Center

Justin Chang, MD, chief of emergency services, Kaiser Perma-nente, Colorado, and medical director, Exem-pla St. Joseph Hospital Emergency Department


Five Success Factors Offer Practical Guidance for PhysiciansBy Andrew Schwartz

?What’sNextACOs


?When the Centers for Medicare & Medicaid Services (CMS) released proposed regulations for its Shared Savings Program (Medicare fee-for-service accountable care organizations), it took one step forward in what could be a transformation of the U.S. health system. Though the proposed rules will stoke existing concerns about Medicare ACOs, they do begin to "esh out a vision where health care stakeholders work to-gether to achieve enduring community health. The next step—ensure those stakeholders have buy-in.

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What’s

ACOsfor

WEB EXCLUSIVE>>Find the latest news and insights on accountable care at our ACO portal: optuminsight.com/ accountable-care-organization

http://optuminsight.com/accountable-care-organization


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SUSTAINABLE HEALTH COMMUNITIES

O n March 31, 2011, CMS de!ned ACOs as structures that “create incentives for health care providers to work together to treat an individual patient across care settings—including doctors’ of!ces, hospitals and long-term care facilities. The Medicare Shared

Savings Program will reward ACOs that lower growth in health care costs while meeting performance standards on quality of care and putting patients !rst. Patient and provider participation in an ACO is purely voluntary.” The 429 pages of proposed regulations focused largely on providers—physicians and hospitals—while carefully de!ning many of the requirements for participation, patient attribution, payment models and a host of other elements.

The OptumInsight concept of a Sustainable Health Community, however, aims to ensure all stakeholders—physician, hospital, patient, pharmacy and payer—are involved in, and accountable for, optimizing the health of individuals and entire communities of people. Most of the efforts toward this goal will be market-led, rather than government-led, and how groups get there is more open-ended than what CMS is proposing.


3

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THE BIGGEST LIFT WILL COME FOR GROUPS WHOSE PRACTICE PATTERNS SHOW CONSIDERABLE PRACTICE VARIABILITY.


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ADDRESSING PHYSICIANS’ BIGGEST CONCERNS I

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ENGAGING THE PHYSICIAN COMMUNITY TO CONNECT DISPARATE EMRs

S ince 1993, Utah Health Information Network (UHIN), a state nonpro!t organization, has been working to improve the administra-tive side of health care through the use of electronic data interchange. Over the past three years, UHIN has been trying to ensure

clinical standardization, as well, by creating a health information exchange (HIE) for Utah. UHIN membership includes 90 percent of Utah medical providers, so physician buy-in was key to a successful launch.

“UHIN was fortunate as we already had a relationship with the providers through our administrative exchange,” says Teresa Rivera, chief operating of!cer at UHIN. “With that established relationship, we were able to request provider participation as we moved into the clinical exchange.”

In fact, providers helped create the request for proposal and choose a vendor for the HIE system—Axolotl’s Elysium® Exchange. This strategy was mutually bene!cial. The physicians could take ownership of the process rather than have a system forced upon them, and the discussions that took place surrounding the HIE selection allowed UHIN to gain further insight into clinical concerns. Equally impor-tant, the support of the current Clinicians Committee has furthered the adoption of the clinical exchange among the providers’ peers.

“The Clinicians Committee has helped us prioritize projects, determine user roles and customize the product,” Rivera says. “Their support is critical to the success and growth of the clinical exchange.”

Since implementation, Axolotl’s Interoperability HUB (I-HUB) has allowed for adoption of a single, virtual patient record and con-nected disparate EMRs throughout the state. With this process in place, UHIN has further plans to improve the exchange of information by creating an immunization registry and funneling insurance eligibility through its clinical exchange. – Katherine Osos

“”

WITH PATIENTS FREE TO MOVE IN AND OUT OF THE ACO AT WILL, ATTRACTING MEMBERS AND KEEPING THEM ENGAGED IN THEIR OWN CARE AND WELLNESS BECOMES PARAMOUNT.


As the accountable care organization model comes into focus, so does the requirement for a robust health information infrastructure

The POWER of IT to Transform Health Delivery

BY DOUGLAS CLARK


The POWER of IT to Transform Health Delivery


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The most fundamental change for health organiza-tions will be to create a system that is built around an accessible and broad view of health.


“”

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Listen to our exclusive podcast with Anthony Shih at ignite.optuminsight.com

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sparksA MOVEMENT

CMSNew ACO regulations initiate the movement toward collaborative care



sparksA MOVEMENT


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CMS has taken steps to unify the payment systems around a core set of measures that will harmonize provider and payer activities.


Perspectives

Opening the Door to Reform?3&6$-)1/.'&,#H!)165&/).

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To learn more about our vision for Sustainable Health Communities, visit ignite.optuminsight.com

WEB EXCLUSIVE>>

About OptumOptum is an information and technology-enabled health services business platform serving the broad health marketplace, including care providers, plan sponsors, life sciences companies and consumers. Its business units – OptumInsight, OptumHealth and OptumRx – employ more than 30,000 people worldwide who are committed to enabling Sustainable Health Communities.

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Because we are continuously improving our products and services, OptumInsight reserves the right to change speci!cations without prior notice. OptumInsight is an equal opportunity employer. © 2011 OptumInsight

OptumInsight™ | www.optum.com

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THE ACO VISION FACTORS FOR SUCCESS€¦ · Holly Michaels Fisher Vice President David W. Plocher,...

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