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Building Accountable Care, Block by Block

January 14, 2012
by Mark Hagland
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Healthcare Industry Expert Joe Damore of Premier Is Helping Hospitals and Health Systems Move Forward on ACO Development

In 2010, the Charlotte, N.C.-based Premier Health Alliance created two working groups to assist its hospital and health system member organizations to prepare to participate in the Medicare Shared Savings Program for accountable care organizations (ACOs), one of the voluntary programs created by the Affordable Care Act (healthcare reform) in 2010. As Premier’s website explains, the ACO Implementation Collaborative is designed to help Premier member organizations “pursue ACOs for patients today, leveraging existing payer partnerships and a tightly aligned, engaged physician network.” Meanwhile, “The ACO Readiness Collaborative is designed for health systems that must first develop the organization, skills, team and operational capabilities necessary to become ACOs and ultimately joint the Implementation Collaborative. Altogether, nearly two dozen health systems, representing several dozen hospitals, are already actively participating in the collaborative.

One of the key Premier executives involved in helping the organization’s hospital and health system member organizations to prepare for ACO development has been Joe Damore, whose title is vice president for the implementation collaborative. Damore, who spent about 30 years in healthcare management, as a senior executive in numerous hospitals and health systems nationwide, joined Premier in January 2011, and has been deeply involved in ACO development support there ever since. Damore will be addressing these issues in an educational session at HIMSS12 in Las Vegas on Feb. 20 (“A Capability Framework For Accountable Care”).

Damore spoke recently with HCI Editor-in-Chief Mark Hagland regarding his leadership in this area and the lessons being learned about accountable care work in the collaborative and across Premier to date. Below are excerpts from that interview.

Tell us a bit about how your professional background dovetailed with the needs you are now addressing at Premier?

I’ve spent about 30 years in management, first, with several different hospitals and health systems, and including about 20 years as a CEO. My philosophy was, I tried to build integrated health systems. The model that I thought was the most logical model was creating regional integrated health systems, and I went to Greenville Hospital System in Greenville, South Carolina, because Bob Toomey was trying to build integrated care there; that’s what I did at several different organizations, in fact. Now at Premier, I get to work with really progressive organizations, to manage, measure, and improve the health of populations all across the country. I get to work with organizations like Fairview in Minneapolis, Presbyterian in Albuquerque, Banner Health in Phoenix, and AtlantiCare in Atlantic City, New Jersey, WellStar [Health System] in Atlanta, and Baystate Health in Springfield, Mass. Those are members of our collaborative, and I would rank those among the most progressive organizations in the country. I visited at least 40 organizations across the country the last year.

Joe Damore

What are the biggest lessons that you and your colleagues have learned so far?

One of the first things we’ve learned is that you’ve got to build an integrated care model, encompassing the full continuum of care, at the local level; you’ve got to figure out how to integrate hospitals and physicians across the full continuum. For instance, how do you integrate private physicians into such networks? We’re calling them clinically integrated networks (CINs), or clinically integrated PHOs [physician-hospital organizations]. The big difference between these organizations and the PHOs of the 1980s and the 1990s is that these clinically integrated PHOs are fully integrated. The FTC [Federal trade Commission] actually developed criteria around this in 1996; in fact, not many places adopted those criteria at that time. Now, many are interested. So this first area of effort involves clinical integration at the local level.

Generally speaking, there are three broad areas of initiative involved here. There’s development of the clinically integrated network; development of the partnership with physicians; and then the development of care management techniques, including the patient-centered medical home [PCMH]. And I would tell you that the early research I’m seeing on the patient-centered medical home is extremely positive. The data we’re seeing is showing about a 7 to 8 percent drop in costs. Three sources: Geisinger [Health System, Danville, Pa.] has done an analysis, and by the way, they’re one of our members, and an early adopter of the PCMH concept. A second source is [Seattle-based] Group Health Cooperative; and the third I’ve seen is Cigna’s experience in employing PCPs [primary care physicians] in the Phoenix area. They’ve developed 23 patient-centered medical homes in Phoenix, and their experience is the same.

I was on a panel in Phoenix with a medical director for the Cigna program; this was at an Arizona chapter meeting last year of the ACHE [American College of Healthcare Executives].

How do you get the physicians to integrate with you when in most markets there has been a history of mutual mistrust?