Care Implications Under the ACO Model

As more providers adopt ACO models, changes are in store for clinical operations. What does hospital management need to know? A Q&A with Dr. Andy Ziskind.

CG: How will care delivery change under the ACO model?

Dr. Andy Ziskind: More care will be delivered in outpatient settings. What we know is a lot of the interventions used in ambulatory settings help keep people healthier and reduce inpatient utilization. Providers need to get better at coordinating care so patients can receive care in the best setting.

CG: How will providers adapt?

AZ: Hospitals need to expand their competencies and develop much better systems to coordinate care across the continuum. In part, that may require redirecting case management to manage transitions. It also may require partnering with a payer that has other capabilities. We are definitely seeing a growth of patient care coordinators who are responsible for the patient regardless of location.

CG: How can technology help facilitate changes to care delivery?

AZ: Two major areas that everybody needs to keep their eye on are analytics and patient engagement. There has been a lot of investment in electronic health records and computerized practitioner order entry. But the true value of that information hasn't yet been realized. By applying analytics capabilities, we can start to predict which patient needs which resources in the right place at the right time.

We've seen analytics in other industries make a dramatic difference. Wal-Mart can tell you which cereal box on which shelf position will sell better on a Tuesday afternoon. We need to use the same kind of data to focus our care management resources on the patients that need it most.

Data from Fairview Health Services in Minnesota suggests that patients who are engaged and activated are at least 8 percent less expensive to care for. Right now, the market is exploding with technologies that enhance patient engagement.

CG: Integrated networks and multi-disciplinary groups have strong potential to succeed in the ACO world. What is your advice for less-mature health systems and independent providers to achieve success?

AZ: First determine whether you have the right delivery system to start managing patients across the continuum of care. Then, decide if you have the fundamental cost structure to be successful. If you don't have core operating efficiencies on a cost-per-case basis, you're not going to be successful because your costs will be too high. Once you determine those two things you'll be able to focus on fundamentally redesigning processes across the continuum.

CG: Culture change among physicians has been a challenge for early ACO adopters. How can this be addressed?

AZ: We're seeing a revolution in hospital/physician alignment, but that requires a change in clinical governance models. There's a huge demand for effective physician leaders and administrative leaders who can effectively build bridges with physicians. Using data to drive decisions helps physicians when asking them to modify practice patterns or address cost or quality.

Dr. Andy Ziskind is a cardiologist with over 25 years of experience spanning clinical care and academic health system leadership for physicians and hospitals/health systems. To discuss your organization's strategic challenges, contact Andy at [email protected]or 312.405.7298.