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ACO Leaders Explain: Healthcare First, Then Savings

February 15, 2013
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 “The way I look at things – we are ‘all ACO [accountable care organization], all the time.’ We don’t look at this like the ACO is part of what we do. We are an accountable care organization. Everything we do is part of the ACO process. The way I express it is…we’ve bitten from the fruit of the tree of knowledge. We’re so passionate about value, about having learned there are better ways of providing care. It’s not about less cost. It’s about better care first and foremost, and better health. It’s an incredible journey, it’s not easy, and it’s really turning the way we practice medicine on its head.”

-Hal Teitelbaum, M.D., Managing Partner and CEO, Crystal Run Healthcare (Middletown, N.Y.)

I could have gone with that quote. Dr. Teitelbaum had a number of other gems. I would love to one day get a chance to speak with him one-on-one. He’s seems to be one of the industry’s brightest minds, especially when it comes to this topic. His point is this: being an ACO is a way of life, and that way is centered on better healthcare. The lower cost part? That will eventually come.

This was one of the main takeaways from an engaging webinar held this week by the standards-based, private, non-profit organization, the National Committee for Quality Assurance (NCQA).

The webinar featured Teitelbaum and other executives from six different organizations that were among the first to get ACO accreditation from the NCQA. The executives talked about why they got ACO accredited from NCQA, what they learned going through the process of becoming an official ACO, and what ACO Initiatives they are planning to pursue to engage others in community.

The best part for me was Teitelbaum and others musing on what it means to be an ACO. So few organizations, many of which claim to be an ACO, have this kind of accreditation to back it up.

 Teitelbaum said in talking about the “triple aim” (better health, better care, lower cost – as the conceived the Cambridge, Mass. Institute for Healthcare Improvement), that the organization focuses on the first two elements. And when focusing on best practices, he added, the elimination of waste and cost comes naturally.

Of course, this is easier said than done. With certain frankness, Teitelbaum acknowledged that his organization was still compensated through traditional volume-based methods, rather value-based outcomes. As he said, the organization is essentially functioning with a foot in two canoes.

“We’re in the process of transitioning to value when much of the world is still functioning in volume. Every time we standardize around best practices, improve efficiency and eliminate waste that potentially results in decreased compensation to providers and others in the healthcare system,” Teitelbaum says.

The transition will be harder for specialists, the executives said during the webinar, who are used to dealing in episodic care. Still, Crystal Run, and others like it, trudge forward having a firm belief in the ACO movement.

I’d be remiss in not mentioning that part of this movement is something that, Teitelbaum, Trude Haecker, M.D., medical director of quality improvement at the Philadelphia Children’s Hospital, and others on the webinar, spoke of as being essential ingredients to getting officially certified as an ACO. Those ingredients are robust analytics, an EHR, and business intelligence.

The health IT factor cannot be understated. When writing an upcoming trend piece on payer/provider collaboration (look out for it next week), I noticed that much of this collaboration is based on health IT capabilities.  Take for example the ACO partnership between the Hartford, Conn.-based Aetna and the Flemington, N.J.-based integrated health system, Hunterdon Healthcare.

For the ACO, the two organizations are each providing an appetizing array of health IT systems including a full electronic medical record (EMR) from NextGen (Horsham, Penn.), clinical information systems on the inpatient side from QuadraMed (Reston, Va.) health information exchange from Medicity (Salt Lake City), clinical decision support tools, a picture archiving and communication system and an OR system as well.

This is just one example of many that are popping up all over the country. Type in ACO in Google News and you’ll get an idea of what I mean.

It shouldn’t be that surprising, as these strange marriages are part of the equation. Dr. Teitelbaum mentioned that you have to partner with like-minded organizations and have aligned goals and incentives. It can’t be an interesting thing to them, he said, but rather it should be a “belief system.” Basically, the ACO way of life, mentioned above, has to cross organizational boundaries.

I guess that means there are multiple feet in two canoes. Let’s hope no one falls in.

Thoughts, experiences on ACOs? Please feel free to respond in the comment section below or on Twitter by following me at @HCI_GPerna