Laying the Operational and IT Foundations for Summa Health’s ACO: The COO’s View

There are three components to that aspect of the work. First, there’s real-time information at the point of care. It involves a disease registry that can identify gaps in care among a population a physician is managing. And the third is population health analysis. The first part, Greg Kall is building, and the goal is to have a vendor selected this year and begin the implementation process in 2013; and it’s like anything else, in that you evolve forward, working with the different types and groups of physicians. But over the next couple of years, we should have that, and it should be pretty robust, to the point where all the community physicians working with us have that information. The disease registry is in place today.

The second component involves the clinical measures for the physicians—the 33 clinical measures that CMS [the federal Centers for Medicare and Medicare Services] says we need to be able to report on and improve—and we’ll be paid based on those. And we’ll be using the MDDataCore product to help us with that process. The third element is the population health analysis. And right now, we’re utilizing claims data to help us do this until the HIE can go live. So we’ve got a health plan, SummaCare, that we’re working with, and we’re working with Premier to help us find a vendor that can help us do the analysis as well. So today, when we get the file from CMS on the claims data, we’re going to be able to populate a database, and that will generate where we’re at with our current population.

When you look at the challenges ahead, do you feel pretty confident that you will be successful?

Absolutely. What the model looks like will continue to evolve, but absolutely we’ll be successful. The hospitals are very much engaged and want to see this be a success. The community and employed physicians very much want to see this be successful. The payers very much want this to be successful. Now, what this ultimately will look like, time will tell, but all three communities are engaged, and we know that these kinds of changes need to be made in healthcare. The question is, how quickly can you implement an HIE? How quickly can you implement some of these changes to physician practice? How quickly can you implement the patient-centered medical home model? So it’s just a matter of how quickly we can move forward on this new model. CMS has now given us a new payment model to allow this to happen. And SummaCare is working with us on the Medicare Advantage population.

Do you believe that the ACO model can succeed in a variety of markets and among a variety of different types of organizations?

Yes, I do believe there are a number of types of models that can succeed. The challenge is moving clinical care practice more towards this value-based model. If you’re moving only 5 percent of your population into a value-based model, it’s hard to justify the investment in infrastructure; but if you’re moving 90 percent of your population into a value-based model, it’s not hard to justify the investment at all.