Much has been written and will continue to be written about accountable care organizations, whether they are labeled Pioneer, Shared Savings or offered through commercial carriers. There are many respected healthcare leaders who think that ACOs will bring great benefit to patients and providers while bending the cost curve.
The ACO journey
Why one prominent provider is embracing the change
There are also a similar number of respected healthcare leaders who are skeptical of such claims. The true impact of ACOs will play out over the next several years and beyond.
The ACO concept generally suggests that an organization of healthcare providers (physicians, mid-level providers, hospitals, ambulatory surgery centers and post-acute providers that deliver the continuum of a patient's care) work together in an organized approach and be held accountable for the quality, cost and overall care for an assigned population of patients. All providers involved in a patient's complete continuum of care will be connected electronically and have access to and share the assigned patient's medical information. Based on the data and individual patient needs, providers will engage this population, coordinating and managing each patient's care to not only provide better care, but to do so in a more cost-effective manner.
This concept is being explored (Jan. 2) because the organizations and entities that are paying the bills (Medicare, Medicaid, employers, commercial insurers, etc.) see the current model as not financially sustainable. In addition to the cost concerns, these organizations and entities, and the patients they represent, also are clear that the healthcare system should be producing better quality outcomes for the patients and populations served.
Sharp HealthCare is a fully integrated healthcare delivery system in San Diego. We have four acute-care hospitals, three specialty hospitals, two affiliated medical groups, a full spectrum of post-acute services (including skilled-nursing, home health and hospice) and our own health plan. We provide more than 28% of the inpatient admissions and a similar makeup of the ambulatory-care provided in the San Diego marketplace.
Despite the many unknowns around the ACO concept, consistent with Sharp HealthCare's history, we are committed to the exploration and development of innovative payment models that are aimed at delivering coordinated, patient-centered care that sets community standards, exceeds patient expectations and are provided in a convenient, cost-effective and accessible manner.
We have a record of accepting different payment models, having taken fully delegated risk for patient populations since 1985 (including more than 280,000 patients for which we receive a population-based payment today), and have worked with payers and our health plan in the development of narrow networks, tiered products and other arrangements that we think better align payment and delivery. We believe providers should be leaders in defining the solutions to the current models. Together with our affiliated physicians and the people of Sharp HealthCare, we want to be part of the solution, and we believe we can make a difference.
We are proud to have been selected as a Pioneer ACO and look forward to actively engaging with our 32,000 aligned beneficiaries in a manner that will improve their health and enhance their outcomes. In addition to our Pioneer ACO, our affiliated medical groups have also entered into ACO agreements with two commercial carriers covering approximately 21,000 attributed beneficiaries.
We see these ACO models as a vehicle to expand our significant existing managed-care infrastructure and experience to patients who have not been engaged with their providers along the entire continuum of care. We are confident that utilizing data analytics that include the complete spectrum of a patient's medical history, and connecting our providers with this information, will yield positive results through a comprehensive and coordinated approach that best meets patient and provider needs, resulting in higher quality and a more cost-effective outcome.
That's not to say the ACO journey will be an easy one. Even within our established integrated healthcare delivery system, we have significant investments and improvements to be made in the areas of care management, informatics, patient engagement and transitions of care along the continuum to name just a few. These improvements will not only make us better for our ACO populations, but will make us a better organization for every patient we see. As providers begin to implement ACOs, we are sure there will be organizations that will do it well and help us all define a better model for the future. We also are sure that there will be organizations that will struggle and not have great success, and we will learn great lessons from them also.
Sharp has long believed that an integrated, coordinated approach across the full spectrum of care results in better quality outcomes, provides patients and their families with better experiences and is more cost-effective. We are looking forward to the exploration and innovation that will occur at Sharp around the ACO approach. We are confident that our efforts will result in great lessons for us and others, and we know that through this process we will all improve.
The Pioneer ACO is neither a boondoggle nor a panacea; it is a part of a journey to a system that produces better care for individuals, better health for populations and reduces the historical healthcare cost trend. And this is a journey we must all embrace.
Mike Murphy is president and CEO of Sharp HealthCare, San Diego.
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