Value Based Payment

New Accountable Care Collaborative Shares Provider Stories

November 10, 2016 9:49 am

Accountable care is an attainable, worthwhile goal, but it requires education. A new collaborative is working to fill that gap.

Many healthcare organizations are striving to implement accountable care strategies, but the path to that goal is not always clear. A year-old organization, the Accountable Care Learning Collaborative (ACLC), aims to help hospitals and other healthcare organizations achieve accountable care goals by sharing the knowledge, experiences, and best practices of successful healthcare organizations.

“We see providers getting into accountable care—voluntarily or being pushed into it—but they don’t have a good understanding of what to do to improve care delivery,” says John Poelman, executive director of Salt Lake City-based ACLC, which is composed of 70 members from health plans, hospital systems, physician groups, academic organizations, medical product manufacturers, and other stakeholders. “There’s a common belief among members of our coalition that for the whole industry to advance, we have to share this information broadly.”

In addition to market changes, recent legislative and regulatory developments are making a difference in healthcare providers’ abilities and motivations to embrace accountable care. For example, the Medicare Access and Children’s Health Insurance Reauthorization Act (MACRA) is rapidly forcing physician groups and other healthcare organizations to adapt to payment systems based on value more than volume, says Donald Crane, CEO and president of Los Angeles-based California Association of Physician Groups (CAPG) and one of the signers of ACLC’s recent “Call for Collaborative Action.”

“This law [MACRA] creates strong incentives that very nearly mandate that providers turn on a dime and begin to be paid in a different way, where their pay reflects quality and other measurement domains,” Crane says. “This is not utterly new—in most regions there has been some level of pay for performance—but it’s never been deeply rooted in the fabric of physician compensation. So providers have to transform their practices in fairly significant ways, which entails a lot of learning. And that’s what ACLC is all about.”

Learning from UT Southwestern

As part of its educational initiative, ACLC is collecting case studies that can graphically illustrate how various organizations are dealing with accountable care issues.

For example, one case study explains how the University of Texas (UT) Southwestern Medical Center tackled ACLC’s governance and culture competency, identified as “engage physicians and clinician leaders throughout all levels of the organization to carry out and drive value-based objectives.”

The case study explains how UT Southwestern developed a governance structure by creating “pods” of 10 to 15 physicians organized by geographic region into self-governing groups.

“The ACO’s pod structure has proven to be a valuable avenue for engagement in many ways,” the case study reads. “First, the pods create smaller, more tangible networks for motivation and support. For example, the ACO gives its physicians access to quality and cost outcomes data on all of their pod peers.”

The case study also shares challenges, UT Southwestern’s partners, and the medical center’s results. For example, UT Southwestern’s ACO earned a Medicare Shared Savings Program (MSSP) bonus of $14.2 million in 2015.

More two-page case studies, similar to the UT Southwestern story, will be released in 2017 and will illustrate how organizations have developed solutions for specific competencies, including challenges encountered and tools and resources used.

“We envision developing more than 50 case studies over the course of the year. If the program is successful, we believe people will come forth and submit their own case studies,” Poelman says.

“The spirit of this is a call for collaborative action,” he says. “The information about what it takes to succeed in accountable care is siloed, and if we want to succeed, people need to come forward and share it. And I’ve been impressed: Most organizations want to share. In healthcare, there really is an altruistic compassion.”

Identifying Competencies

ACLC’s educational efforts are organized around critical accountable care competencies that counterbalance an emphasis on payment models. The group has identified seven main competencies:

  • Governance and culture
  • Financial readiness
  • Care coordination
  • Patient centeredness
  • Quality
  • Health IT
  • Risk assessment

Workgroups have been created for each of the competencies. During the past year, the workgroups—composed of individuals from the 70 participating organizations—met five times to survey existing literature, discuss experiences, and create white papers outlining the specific, smaller competencies needed to master each main competency. Those seven white papers were released in September and are open for public comment.

The white papers divide the specific competencies into various categories. For example, the white paper on financial readiness includes seven competencies on financial systems and four on strategy and business development.

The competencies theoretically could be used as guidelines for training. For example, competency FR.1.5 reads, “Organize and design financial measures based on specific patient populations.” From that description, a hospital human resources staffer could potentially evaluate and train individuals on that topic.

“Our next step regarding the competencies is to stratify them by organization type,” Poelman says. “For example, one type may be an ACO led by a physician group. Another may be an integrated delivery system. We will customize the competencies by different provider structures.”

To further improve their usefulness, the competencies will also be prioritized. In some categories there are too many competencies for a provider to easily digest, so ACLC is identifying the most important. “We are taking the competencies and saying which you need from the beginning, and which can wait,” Poelman says.

Teaching the Competencies

Telling providers which competencies are important in which situations is a worthwhile endeavor, but it doesn’t automatically make providers better. The missing element is educational resources.

“We’re a small not-for-profit so our expertise lies in directing providers to resources where they can get support,” Poelman says. “We want to develop a resource directory that will direct providers to associations, collaborations, educational institutions, programs, and vendors who can provide that educational link.”

One potential resource is Crane’s organization, CAPG. California has experimented with capitated and pay-for-performance programs for the past two or three decades, so California organizations have deeper experience with accountable care than the average provider, says Crane.

“One of CAPG’s missions is to share know-how and help physician groups deliver on the Triple Aim, and we’re happy to work with the ACLC to get this work done,” Crane says.

Recognizing a Path

The major task of moving from fee-for-service models to accountable care-focused organizations will require a focused effort from healthcare stakeholders as well as a desire to share experiences and tear down silos. Collaborative efforts like ACLC are demonstrating that healthcare organizations are up to the challenge.

Interviewed for this article:

Donald Crane is CEO and president, California Association of Physician Groups, Los Angeles.

John Poelman is executive director, Accountable Care Learning Collaborative, Salt Lake City, and senior director, Leavitt Partners.


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