The Journey Toward Accountable Care

The Federal Trade Commission (FTC) recognizes “clinically integrated networks,” or CINs, as legitimate collaborations of otherwise competing providers organized in a way that improves efficiencies in care delivery. To satisfy the FTC's test, they must demonstrate a high degree of interdependence and cooperation to control costs and ensure quality. CINs also typically rely on clinical analytics and reporting, reinforcing the adage “you need to measure what you wish to manage.” Clinically integrated networks are a starting point, and some would say a necessary precursor, towards care accountability.

St. Vincent's Health Partners in Bridgeport, Connecticut is one example of a CIN. Recognizing that cooperation among providers on behalf of a single patient is essential to addressing care improvements, the clinically integrated network zeroed in on transitions-of-care, typically a weak link in health care systems. St. Vincent's Health Partners holds biweekly transitions-of-care meetings with multiple stakeholders from acute and post-acute care settings. This practice has helped them to uncover inefficiencies and improve the flow of information.

Another milepost on the journey to accountable care is financial integration, in which participating providers assume responsibility for the quality and cost of care for a defined population. Banner Health Network is comprised of 3,000 Banner Health-affiliated physicians and advanced practice providers, 15 Phoenix-area Banner Health hospitals and a variety of other medical facilities.

Through a highly coordinated patient care experience and collaboration with companies like Aetna, Banner Health Network achieved $5 million in shared savings in its first year of operations and improved the health of patients through higher cancer screening rates, better blood sugar management in diabetic members, reduction in use of radiology services, and fewer avoidable hospital admissions.

There are many pieces to the accountable care puzzle to achieve clinical and financial integration: care coordination and management, health information technology, analytics, consumer engagement, provider network development and more. Many of these functions are new to provider organizations, and require significant cultural change and adaptation.

Accountable care is about evolving relationships between hospitals, physicians, and payers at a locally-driven, patient-centered level. The journey may feel long, but accountable care can be achieved with the right partners and a shared commitment to improving the health of populations and creating a more sustainable system.

_{*Clinical Integration: Population Health and Accountable Care is an independent work of Ken Yale, and not funded, endorsed or otherwise associated with Healthagen or Aetna.}

Healthagen is leading the transformation to a simpler, more affordable health care system. Through population health, clinical care management and value-based care expertise, we help providers improve quality and value. www.healthagen.com.

About the Author

Kenneth P Yale is Vice President, Clinical Solutions for ActiveHealth Management