A Model For Integrating Independent Physicians Into Accountable Care Organizations

Abstract

The Affordable Care Act encourages the formation of accountable care organizations as a new part of Medicare. Pending forthcoming federal regulations, though, it is unclear precisely how these ACOs will be structured. Although large integrated care systems that directly employ physicians may be most likely to evolve into ACOs, few such integrated systems exist in the United States. This paper demonstrates how Advocate Physician Partners in Illinois could serve as a model for a new kind of accountable care organization, by demonstrating how to organize physicians into partnerships with hospitals to improve care, cut costs, and be held accountable for the results. The partnership has signed its first commercial ACO contract effective January 1, 2011, with the largest insurer in Illinois, Blue Cross Blue Shield. Other commercial contracts are expected to follow. In a health care system still dominated by small, independent physician practices, this may constitute a more viable way to push the broader health care system toward accountable care.

Many Accountable Care Organizations Are Now Up And Running, If Not Off To The Races

“…Over two years, the annual growth rate in per member per month costs was about 3 percent-less than half the growth rate of the previous decade. 5 Hospital days and readmissions both declined 15 percent in 2010. That helped save more than $20 million, exceeding the agreed-on $15.5 million savings target and allowing Blue Shield to keep CalPERS's premiums in Sacramento flat for 2011.…”

A Framework For Evaluating The Formation, Implementation, And Performance Of Accountable Care Organizations

“…3,4,14 The current version of the logic model is provided in the online Appendix. 15 Exhibit 1 presents an abridged, schematic overview of the logic model with some specific examples of implementation activities, measurable outcomes, and associated potential impacts.…”

To make or buy patient safety solutions

“…In a comprehensive review of the management research on health care quality of care, Nembhard et al (2009) pinpoint the prevalence of implementation failureVinconsistent and improper use of innovationsVas the root cause of the slow and spotty record of patient safety improvement. Furthermore, as some observers have remarked (Shields, Patel, Manning, & Sacks, 2011), enormous are the resource needs of health care organizations to make significant quality improvements. Thus, hospitals taking on these tasks internally for the most part, as we believe TCE predicts, is a fraught enterprise, notwithstanding that those hospitals doing anything whatsoever, which RDT predicts, have advantages in their ability to garner the required resources.…”