When the Department of Health and Human Services released a list of 89 new participating accountable care organizations (ACOs) under the Center for Medicare and Medicaid Services’ (CMS) Shared Savings Program on July 9, one of those listed was NewHealth Collaborative, created by leaders at or affiliated with the Akron, Oh.-based Summa Health System. Late last month, HCI Editor-in-Chief Mark Hagland interviewed Rodney Ison, M.D., chairman of NewHealth Collaborative, regarding the core strategic opportunities and challenges involved in moving forward with this ACO initiative.
More recently, Hagland interviewed Charles Vignos, who is president of the Summa Health Network, the physician-hospital organization (PHO) and vice president of managed care at Summa Health System, and who is now also COO of NewHealth Collaborative, regarding his perspectives on this important initiative. Vignos has been with Summa Health System for about eleven years, and has a healthcare finance and accounting background. Below are excerpts from that interview.
What have been the biggest strategic and operational challenges in laying the foundation for the ACO?
One has been reaching out to the independent community physicians, and providing them with the appropriate education and understanding of what this model is designed to do. And then dovetailed to that has been the fact of rolling out initiatives within their clinical practices within the ambulatory setting that implement the changes in the clinical delivery of care that we’re looking to implement. And quite honestly, the last has been the trust factor. Historically, hospitals and physicians have worked in their own silos, trying to reach their own objectives. So a key element has been achieving transparency, in terms of objectives, in terms of clinical outcomes and everything we’re trying to accomplish. You’re trying to create that alignment between the hospital, the physicians, and the payer, which in this case is CMS, on behalf of the patient.
How hard has it been to explain these broad changes in healthcare payment to the physicians?
We’ve been working with physicians for years now; we started this journey in 2005, and it really started with an IT platform back in 2005. The physician leaders have been very much engaged. What has been challenging has been to communicate it down to their peers or partners, or employees, depending on what kind of model they have on their medical group staff, and to implement those workflow changes.
That’s the challenge, getting it down to that implementation stage. At a high level, they all buy into the “Triple Aim” from IHI [the Cambridge, Mass.-based Institute for Healthcare Improvement’s initiative to improve the health of populations, reduce the per capita cost of healthcare, and improve the patient experience]. So it’s, how do you improve the care quality, while at the same time improving patient satisfaction, and also reduce costs? So they buy into the concept, but the challenge is how that translates into what they do every day. So the issues need to be articulated to each of the audiences involved.
What was the initial IT component?
In 2005, we started a selection process for the physicians in our community to move forward on electronic health record (EHR) systems. Now, in terms of staff, we have about 25 employees under Summa Health Network, and we’ll probably have close to 25 employees under the collaborative. We’ve got about 450 physicians in the ACO—and 275 of those are employed, and 175 are independent physicians participating in this.
The EHR selection process was through the PHO, originally?
Yes. And the PHO was on a journey to develop a clinical integration model for the physicians in the community, and a key element of that was moving the physicians onto an electronic medical record system, and we’re continuing with that process. And dovetailed with that, we began to extract data from their EHRs, and we’ve been using MDDataCore as our vendor.
When did you begin to extract data?
About 2009. We do have a data warehouse. It’s a web-based product that gives them access to their clinical care gaps around chronic management, things like diabetes, hypertension and cardiovascular disease; it documents care gaps around mammographies, colonoscopies, and other wellness screening issues, via a dashboard. It’s an after-the-fact, retrospective review of how they’re managing their populations.
Are you hoping to make it more real-time?
That’s what Greg Kall [Summa’s CIO] has been working on, developing clinical data at the point of care. The data we’re getting is a weekly extract. He’s developing a real-time, HIE [health information exchange]-based process. He’s in a review process as we speak. So he’s looking at what vendors can deliver on that kind of model. The data we get is mainly being populated by physicians’ EHR systems, and we’re getting some hospital lab and diagnostic data, but he’s going to be able to make it real-time for all providers, and add a number of other additional data points as well.
How much of a challenge will it be to create a closed loop of information for the physicians, and how far along are you?