Accountable Care, ACO, Affordable Care Act

Brookings: ‘Big Issues for ACOs Going Forward’

On October 20, 2014 the Engelberg Center for Health Care Reform hosted a half day forum to assess the latest evidence on accountable care, discuss strategies to overcome unique ACO challenges, and provide an overview of accountable care reforms.

Panel participants included:

brookings aco's big issues going forward

Accountable Care, ACO, Affordable Care Act

Patient Engagement in an ACO World

By Gregg A. Masters, MPH

Last June I had the honor or moderating a panel on ‘unlocking innovation in patient engagement’ in an ACO World at MedCity News’s ENGAGE conference. Joining me on the panel are: Libby Webb, Director, Product Management, Athenahealth, Lanie W. Abbott, APR, Senior Communications & Outreach Coordinator, EMHS Population Health Management and Colin Ward, MHS, Executive Director, Greater Baltimore Health Alliance.

During the session we discuss ACO implementation issues and how early movers are mobilizing and organizing to drive sustained patient engagement while conforming to a complicated set of ACO policies. Patient engagement will continue to be the missing link in new value-based reimbursement programs until the quality of patient communications leads to consistent behavior. We discuss how new ACOs are investing in benchmarking tools and communications interventions that will measurably improve the quality of physician-patient communication.

Accountable Care, ACO, Affordable Care Act

Accountable Care, ACOs and the ‘New OS’: An Emerging Zeitgeist?

By Gregg A. Masters, MPH

…or might the movement just be the very oxygen essential to achieve the triple aim?

We’ll get one man’s take on the Wednesday July 24th 2013 broadcast at 12 noon Pacific/3PM Eastern when my special guest is thought leader, deep thinker and advocate for patient centric healthcare Leonard Kish, aka @LeonardKish progenitor of the ‘Patient Engagement is the Blockbuster Drug of Century‘ characterization by Dave Chase.

To listen, go to ‘This Week in Accountable Care‘. This Week in Accountable Care | @ACOwatch | Hosted by Gregg A. Masters

I’ve titled the interview: Leonard Kish On Accountable Care and the ‘New OS’. In a recent blog post Leonard equated the push into Accountable Care (generically speaking and ACOs as one subset) as the equivalent of the ‘new, new thing’ or even zeitgeist shift as the ‘new OS’ required to move the needle forward on our paths towards ‘triple aim’.

Tieing comments from @lumeris VP Jim Hansen on the disruptive nature of ACOS, i.e., ‘Value-based care is a transformational journey, not a backend contract driven program that you overlay onto your existing delivery system organization’s people, processes and technologies and expect different results” to a Microsoft PC/software era value proposition analogy made by Tim O’reily Leonard notes:

..the OS abstracts away the difficulty in managing all the devices and processes the computer runs so applications can focus on what the user wants to do. When Microsoft entered the market in the 80s that was their value proposition, simplicity for developing new applications by abstracting away the other processes. Health care, under value-based payment, will soon have the same opportunity.’Leonard is a deep and insightful thinker in the space, our previous discussion of his take was in the form of ‘dark matter in healthcare: patient goals.

We shall see if the ‘OS’ metaphor holds traction for the transformaton.

To join us live or via archived replay click here.

Accountable Care, ACO, patient engagement

4th National ACO Summit Day 2

By Gregg A. Masters, MPH

Shannon Brownlee Panel

Day two for me started in Track 6: Engaging Patients in their Medical Care, titled ‘Patient Engagement in Healthcare Decision Making‘ breakout session moderated by Shannon Brownlee (@ShannonBrownlee), Senior Vice President, Lown Institute; Former Acting Director Health Policy Program, The New America Foundation; Author, Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer, Washington, DC AND indisputable superstar in the documentary ‘Escape Fire‘.

The panel included:

Glyn Elwyn, BA, MB, BCh, MSc, FRCGP, PhD (@GlynElwyn) – Visiting Professor and Senior Scientist, The Dartmouth Center for Health Care Delivery Science, Hanover, NH

Judith H. Hibbard, DrPH – Senior Researcher, Health Policy Research Group and Professor Emerita, Department of Planning, Public Policy and Management, University of Oregon, Portland, OR

L. Gordon Moore, MD (@lgordonmooreMD) – Chief Medical Officer, Treo Solutions, LLP; Founder of the Ideal Medical Practices, Troy, NY

Chris Saigal, MD, MPH – Associate Professor and Vice Chair, Director of Health Services Research, UCLA Department of Urology, Institute of Urologic Oncology, Los Angeles, CA

I know I was in the right room when in response to one of the presenter opening comments, @shannonbrownlee adds:

‘I’m not my diseases and I don’t want to be managed…I want to be helped’

More later…

ACO, Affordable Care Act, digital health, health reform, HealthIT, Triple Aim

Time for a New ‘IPA’? The Independent Patient Association

By Gregg A. Masters, MPH

India Pale AleFor some ‘IPA‘ is about conversation and spirit enabled conviviality often in micro-breweries scanning the daily options for consumption. While for others IPA conjures up images and memories of labored if not painful efforts to steward the phased transformation of the American healthcare [non]system from a production oriented fee-for-services silo culture to one that is patient centric, team based and ‘what’s best for the patient’ value driven.

FPA Medical ManagementWe were first introduced to the ‘I/P/A’ (independent practice association) acronym in the mid 70s when the HMO Act greased the skids to reach out to mainstream medical staff communities vs. remain domiciled in it’s limited albeit more centrally managed ‘staff model’ (employed physicians) iteration.

Mullikin MedipartnersSeveral decades later, the track record of the IPA to assume, embrace, administer, and ultimately thrive under a prepaid, capitated or otherwise value based compensation system has been a dismal failure. The idea the IPA would seed group practice culture while constituting an increasing share of the individual physician’s practice would ultimately result in ‘urge to merge’ integration of individual practices into a ‘medical group without walls’ if not a fully integrated bricks and sticks merger. Clearly some instances of both have materialized, and there are some IPAs today that remain active and vibrant in the resurrected ACO conversation (Monarch Healthcare and Advocate Health Partners are two such examples).

Yet the cold facts are these, healthcare costs remain out of control and out of reach of many (50+ million uninsured, and 75+ [and growing]  million ‘under-insured), while there is no more ‘there, there to health insurance’ (witness the prevalence of cost shifting, benefit reductions and growth of so called ‘consumer directed [high deductible] health plans’, as the fundamental drivers of medical and healthcare cost inflation remain largely immune to industry efforts to reign them in.

Resistance is futileSo might it be the right time to entertain a new IPA? Where the I/P/A stands for ‘independent patient association’?

Between the power of the crowd to leverage ‘most favored nations pricing’ via massive, ‘club based’ group purchasing, and the potential to empower informed patient choices via the emergence of increasingly friendly, smart phone or tablet enabled devices, might we be on final approach to a truly patient engagement inspired revolution as envisioned in Eric Topol’s ‘Creative Destruction of Medicine‘ to select indicia of Patient Engagement reflected in the Affordable Care Act?

So is this a tech enabled ‘power to the people’ moment which taps into, harnesses and drives the granular re-engineering of our house of cards sickcare [non]system from paternalism to patient centricity? Or might this ‘convergence’ qualify as an @Adbusters scenario of:

When the moment is ripe, all it takes is a spark

Can an army of device or otherwise web enabled empowered patients and/or consumers supported by an association that contractually negotiates the lowest possible price points (hospital, physician and ancillary) via large scale, wholesale group purchasing of ‘most favored nations‘ rates be that spark?

Or otherwise put, can this quantum ‘super-positioning’  be the elusive elixir that finally levels the playing field of an otherwise insatiable fee-for-services supply driven demand economy coupled with opaque pricing that disproportionately favors its hierarchical [‘resistance is futile’] inertia?

Might this be the moment for a ‘new IPA?’


National ACO Patient Engagement Benchmarking Survey

By Gregg A Masters, MPH

Earlier today Avado released a National ACO Benchmark Survey directed to select ACO avadoand accountable care industry executives. A core component of ACO success from both a financial and outcomes perspective, and critical to the fulfillment of the triple aim, ‘patient engagement’ is a broadly cast, locally flavored and otherwise rather ambitious undertaking. In an industry that typically did not have to think in such aggregate (population level or shared governance) nor granular (patient centric, beneficiary engaged) terms, this is no walk in the park. For an itemization of CMS indicia of patient centered-ness see:‘The ACO Must…’ Towards an Operational Definition of ‘Patient Engagement.’

Avado’s CEO Dave Chase introduces the survey as follows:

We invite you to participate in a benchmarking study on readiness for patient engagement. This survey is being sent to hundreds of ACO executives to elevate the importance of Patient Relationship Management (PRM) and the role they can play to positively impact the health and financial outcomes for ACO risk assumption.

The results from all participating ACO executives across the country will be compiled and sent back to you, along with an invitation to view a webinar about the top ten things to know about PRM with at least one of the authors of the forthcoming HIMSS book on patient engagement: “Engage! Transforming Healthcare through Digital Patient Engagement”, as a thank you for participating.

To access the survey, click here. The Deadline for completion is Monday, February 4th, 2013.

Chase continues:

Those who’ve studied patient portals have made the analogy that legacy patient portals are akin to pre-Google web search i.e., low-value and a “marketing checkbox”. Google demonstrated that there was value that could be unlocked. The organizations that understood this early such as Amazon and Expedia gained a massive advantage over their competition that their competitors never recovered from. Likewise, the organizations that recognize the value of PRM will gain a major advantage over their competition while better serving their patients.


‘The ACO Must…’ Towards an Operational Definition of ‘Patient Engagement’

By Gregg A. Masters, MPHaco patient engagement

In the realm of stuff we need to do and sometimes clouded by either ad copy or less than straightforward guru guidance cutting through the clutter can sometimes be confused by the words ‘may’, ‘should’ or other less obligatory statements. For instance:

M/U/S/T | a verb |to:

be commanded or requested to…
be urged to…
be compelled by physical necessity to…

You fill in the blank.

So it’s pretty clear that ‘must’ leaves little wiggle room or cause for doubt when it comes to meeting a certain legal or regulatory threshold or standard. In this case, we’re addressing certain global provisions in the Patient Protection and Affordable Care Act specific to Accountable Care Organizations (ACOs).

CMS previously described ‘patient engagement‘ via the rule making process as:

the active participation of patients and their families in the process of making medical decisions….

[and that] measures for promoting patient engagement may include, but are not limited to, the use of decision support tools and shared decision making methods with which the patient can assess the merits of various treatment options in the context of his or her values and convictions. Patient engagement also includes methods for fostering ‘‘health literacy’’ in patients and their families.

Also consider the balance of criteria or so-called CMS ‘indicia’ of patient centered-ness via Section 425.112: Required processes and patient-centeredness criteria:

“(b) Required processes.

The ACO must define, establish, implement, evaluate, and periodically update processes to accomplish the following:

(2) Promote patient engagement.

These processes must address the following areas:
(i) Compliance with patient experience of care survey requirements in § 425.500.
(ii) Compliance with beneficiary representative requirements in § 425.106.
(iii) A process for evaluating the health needs of the ACO’s population, including consideration of diversity in its patient populations, and a plan to address the needs of its population.
(A) In its plan to address the needs of its population, the ACO must describe how it intends to partner with community stakeholders to improve the health of its population.
(B) An ACO that has a stakeholder organization serving on its governing body will be deemed to have satisfied the requirement to partner with community stakeholders.
(iv) Communication of clinical knowledge/evidence-based medicine to beneficiaries in a way that is understandable to them.
(v) Beneficiary engagement and shared decision-making that takes into account the beneficiaries’ unique needs, preferences, values, and priorities;
(vi) Written standards in place for beneficiary access and communication, and a process in place for beneficiaries to access their medical record.

(3) Develop an infrastructure for its ACO participants and ACO providers/suppliers to internally report on quality and cost metrics that enables the ACO to monitor, provide feedback, and evaluate its ACO participants and ACO provider(s)/supplier(s) performance and to use these results to improve care over time.

(4) Coordinate care across and among primary care physicians, specialists, and acute and post-acute providers and suppliers.

The ACO must—
(i) Define its methods and processes established to coordinate care throughout an episode of care and during its transitions, such as discharge from a hospital or transfer of care from a primary care physician to a specialist (both inside and outside the ACO);”

The pathways to achieve these indicia of patient engagement are perfectly clear, right? Perhaps in the world of mature integrated delivery systems infused with a patient centric mission and committed physician group practice embracing a team based, seamless care culture. But the average ACO tethered to one or more community hospitals via ‘in name only’ cowboy medical groups, I think not.

Now consider the crosswalk and ‘best case(?)’ staged implementation timeline perhaps most accurately reflected in the National eHealth Collaborative’s ‘Patient Engagement Framework’.

Patient Engagement Framework | NeHC

Truth be told we have a way to go before the proverbial ‘rubber meets the road’, both in terms of the technical fulfillment or health information technology side as well as the ‘fit’ inside an ACO given our national state of ‘readiness’ or maturity if you will.

One bit of news likely to add some clarity to the muddy state of affairs that we’ve learned of recently, and is due to be released shortly by Dave Chase et al at Avado, is a survey of ‘Patient Engagement Readiness’ directed to the ACO industry at large including CEO, CMOs, CIOs, CMIOs and others at the center of this ACO/technology/patient interface. We’ll preview this timely and relevant industry survey and will post the results here as well.

Stay tuned, more to follow shortly!