Secrets of Private-Sector ACO Innovation

Yes; most of the technology is there, though I wouldn’t say it’s 100-percent there. But partly, that’s because we’ve built each of our programs from the ground up. The one benefit for us is that we’re not trying to create a platform for a theoretical model for accountable care; we have an actual model. And that sure makes it easier to provide specifications. And that part is good. The hard part is, how many nuances, customizations, can you build in? And the moment you build those, the more you customize those, the more complicated it gets.

Over time, building accountable care organizations won’t be quite as difficult, because certain general models will emerge, perhaps?

I would agree in general, but you have to tie it to you a product—a Medicare pioneer ACO, for example, versus a commercial ACO. I think some of it depends on how deep and how broad you want to be—in terms of risk-sharing. To us, an ACO is only an ACO if you have a hospital organization and a doctor entity, and a health plan, where there’s some level of integration; if you get to that, yes, over time, you’ll find a few different core flavors. And for us, we think that by virtue of having developed a process and toolkit and concepts, and really detailed knowledge of what works and what doesn’t work, we think we have a pretty big lead over our competitors here in California in terms of working with a lot of different types of organizations, in terms of being able to create the platform, instead of having to go with someone else’s platform. So we took a pretty big risk in doing it this way, but now my phone won’t stop ringing with providers wanting to do business with me.

What would your core advice be for CIOs, CMIOs, and other healthcare IT leaders?

The biggest thing—and this shouldn’t be a shock—is that the best thing any health plan can do to make an ACO come to life is sharing as much data as possible, early, and making it as easy as possible to do so. There’s a constant dynamic tension between hospitals and physicians in their relations with one another; at the same time, the one thing they don’t have is the connection to the people who actually buy the coverage, the client. So you’ve got to package the data in a certain way and look at what initiatives we get involved in to share the data in total and create savings in total. So my advice would be make it as simple as possible, and as comprehensive as possible—that is to say, focus on the total costs, not on one individual item.

How do you see the next couple of years, in terms of the evolution of these private-sector ACO programs?

I’m extremely optimistic, or energized, that we’ve found, not the silver bullet, but something that will tangibly improve the relationship among doctors, hospitals, and health plans, or at least our health plan, in order for us to collectively bring the rate of cost, or premiums, down. So it’s essentially a free-market solution to the issue of cost increases. This is tangible and real, and that’s why we started it a few years ago, because we felt that the path that the healthcare system was on wasn’t sustainable over time, so we had to come up with mutual ideas together, to get things started. So it’s pretty exciting.