What Makes an ACO Tick? Three Tips from Tucson
Arizona Connected Care brings together Tucson Medical Center, local physicians, and three federally qualified health centers into an accountable care organization (ACO). The organization is busy implementing payer strategies and encouraging participation by additional providers.

Another key strategy: patient engagement. Tucson Medical Center launched a program called Volunteer U that trains healthy older adults within the local Medicare beneficiary pool to serve as patient advocates to offer support and education to peers who are transitioning from a hospital stay. "We recruited local seniors who were retiring from successful careers but weren't ready to stop contributing to the community. They run support groups and identify discharged patients who may need additional help managing their illnesses," says Friend.

Admission Plan Eases Patient Transition and Care Coordination
Southeast Texas Medical Associates (SETMA) developed an admission plan of care template that helps patients transition into the hospital setting and improves coordination among caregivers. "This tool is intended to help address major problems that can stem from a lack of coordination, such as unnecessary days in the hospital, low patient satisfaction, re-hospitalizations, and inadequate staff communications," says James L. Holly, MD, SETMA's CEO.

A template for the hospital admission plan is built into SETMA's EHR system, which physicians can access in the four hospitals in which they practice. So creating the document adds little extra work for the admitting physician, Holly says. 

SETMA began using the hospital plan of care this summer, and early feedback has been good. "The nurses particularly like this," Holly says. "We have fewer complaints from patients saying, 'No one has told me anything about why I am here or what I can expect!'"

Restructuring Academic Medical Centers for Value
Many academic medical centers (AMCs) face the challenge of distinct governance structures that don't allow the flexibility they may need to embrace emerging evidence-based care models and a call for greater transparency. AMCs often have different boards, leadership structures, and mission statements governing each of their teaching, research, and care delivery functions. These distinct governance structures make it challenging for AMCs to make decisions nimbly and strategically.

The CFO of one academic center noted, "We are using the possibility of a bundled payment project not because we think it will be a big winner for our system, but just to get an early dialogue going between the key elements of our system."

Partners HealthCare and UAB Hospital are making strides in centralizing leadership structures that can make critical decisions on behalf of the AMCs. Partners HealthCare developed a single board with responsibility for all key aspects of clinical care, while UAB Hospital is instituting a funds-flow model that combines all revenue from clinical practice and hospitals into one operation.  

Launching an Innovation Journey
Memorial Hospital of South Bend's innovation journey is championed by its CEO, Phil Newbold. "A lot of innovation projects are experiments that won't make money in 10 months," says Diane Stover-Hopkins, chief marketing and experience officer, Beacon Health System, which is Memorial's parent organization. "The CEO has the authority to protect projects from budget cuts and encourage organizational patience."

Memorial's approach is decentralized with employees empowered to launch projects. "But this is not a suggestion-box model," says Stover-Hopkins. "We develop platforms, or big plays, that we want everyone to address." Current platforms include improving patient safety and home-going instructions. When employees have an innovation idea, they must consider seven criteria to determine if the idea is worth pursuing. The criteria range from the potential to improve value to the employee's passion about the project.

A recent Leadership breakthrough map highlights more about Memorial's innovation journey, as well as the experiences of Presbyterian Healthcare Services.