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No "One-Size-Fits-All" Model for ACOs

February 21, 2011
by Jennifer Prestigiacomo
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At the Siemens Media Breakfast at HIMSS11 on Monday, February 21, Don Paulson, VP of revenue cycle management at the University Hospitals Health System and John Glaser, Ph.D., CEO of Health Services at Siemens Healthcare, both predicted that revenue payments and the transition toward accountable care organizations (ACO) would be a long process, but ultimately would create true ramifications patient for outcomes, cost savings, and organizational makeup.

The Cleveland, Ohio-based University Hospitals Health System uses the Siemens Soarian cycle management (RCM) system to take the mountains of data it collects and manipulate it with interactive rules, so it can scrub it before issuing claims. According to Paulson, his system has a 99 percent clean claims rate, and has been seeing cost savings from its RCM investment. He likes the enterprise wide scheduling tool, which “gears itself toward patient experience” to cleanse data before the first claim, and the fact that his RCM system can create claims with multiple owners that the patient sees as one bill. Paulson also notes that the accountants at his organization like the system the most, as they can get data in one format “so they can challenge the efficacy of their efforts.”

From a financial perspective, Paulson notes that two groups, the elderly and those without insurance, are the two most costly users of ERs. To help manage these patients in the future, Paulson seeks to “make them active partners in care,” and create systems to prompt those patients to make a primary care appointments. “If they interface with their PCP, we can manage care with better outcomes and lower cost,” he says.

Glaser notes that as meaningful use has clear guidance and requirements that healthcare organizations must take to meet attestation, the trek toward accountable care is a murkier journey. The one unambiguous tenant of this movement toward accountable care was that more holistic care would be necessary.

Both Glaser and Paulson agree that this transition toward ACOs, won’t be a sea change that happens all at once, like the creation of Medicare and Medicaid in the ’60s or the creation of Diagnosis Related Groups (DRGs). “We’re heading toward a period where it’s not all going to change at once,” Paulson says.

Paulson also notes that with the new payment reforms, small practice groups will also be pushed toward taking advantages of affiliations with larger entities. He encourages hospitals to build alliances with practice groups to support them through stepping through the process, as primary care is central to the ACO model. He does admit it will be a slow process because of the complexity of the model.

Paulson sees flexibility in the ACO model. “I don’t think it’s going to be one-size-fits-all, [with] different variations of models,” he adds. He also says that with the prospect for analytics, organizations will find cheaper way to do things. “We’re looking for the best fastest way to do it, and that’s probably going to be the cheapest way,” Paulson says.