In November 2015, Leavitt Partners’ Accountable Care Cooperative and the Brookings Institution’s ACO (accountable care organization) Learning Network merged to form the Accountable Care Learning Collaborative (ACLC), which its officials now call the largest accountable care collaborative in the world.
The ACLC, based at Western Governors University (WGU) in Salt Lake City Utah, quickly grew to about 70 member organizations that wanted to take part in this mission. These members are made up of providers of all shapes and sizes, as well as major national payers, industry associations, vendors, manufacturers, and population health enablers.
The core point, says John Poelman, executive director at ACLC, is “we believe that in order to identify for providers what competencies are most needed and what their priorities [should be], you need a cross-industry perspective.” Poelman says, “We have chosen as an organization not to speak directly to a specific payment model, as we are seeing so many different ones with lots of options. We also don’t know what’s coming next.”
Indeed, what the ACLC is truly concerned with is provider readiness for taking on risk, irrespective to different payment models, he says. “We want to give providers a roadmap. What do you need from an infrastructure and culture standpoint?” As such, Poelman recently spoke with Healthcare Informatics about the ACLC’s current work, how healthcare stakeholders are responding to the new administration’s thoughts about the Affordable Care Act (ACA), and how this all might impact the future of value-based care. Below are excerpts of that interview.
Tell me about the ACLC and what its core mission and goals are?
The ACLC is a nonprofit organization with the mission to accelerate the readiness of the industry to adopt accountable care. The founders are Mike Leavitt [former Utah governor and Secretary of Health and Human Services under George W. Bush], and Mark McClellan [former administrator of the Centers for Medicare & Medicaid Services (CMS) under Bush and former FDA administrator].
So both founders have strong policy backgrounds and a lot of the payment reform is being driven from the policy side. There are lots of policy and market pressures on providers to enter into risk-based contracts, and providers are starting to get into these risk-based payments, but they’re not changing the way they are delivering care. So they are not doing a whole lot different, despite getting paid differently. The concern is that people are failing, and you can’t then turn back the clock on the movement as a whole. But the problem is that providers didn’t know where to start or what to prioritize. The vendors out there say they have the right tools and the most important next steps, but they don’t [provide] a great, unbiased roadmap out there to transition your practice to one that assumes risk.
With the member organizations in the ACLC, we have created seven workgroups, each one tasked to identify core care delivery competencies. These workgroups were: government and culture; financial readiness; health IT; care coordination; patient risk assessment; quality; and patient-centeredness. Representatives of these organizations were sent to these workgroups, and they each came up with an itemized list of competencies that providers need in each of these areas. They compiled a large list and they now have over 150 competencies that we have identified and published. We have a membership model to stay funded, but everything goes into the public domain. We are creating a glide path from those competencies and learning from those who are trailblazers, and then translating into a glide path for organizations who are earlier on and trying to figure out the next steps in changing their care delivery models.
One of the ways we are sharing learnings from trailblazers is through our Case Study Brief (CSB) Program, an initiative aimed at distilling real world examples of successful care delivery transformation into targeted and tactical lessons for providers. We just released our inaugural CSB series with 20 case studies. The amount of positive feedback we’ve received from the provider community since the release has been reaffirming of the importance of this work. Providers are looking to find proven strategies and solutions in a digestible and actionable way, and our goal is to help them.
You have mentioned that many providers are ill-equipped to succeed under value-based payments and lack a map of how to move forward. What particularly are they struggling with most?
This is subjective; I can’t speak for ACLC, but we are now identifying the biggest weaknesses. Anecdotally, we are seeing organization culture as an issue so far. A CEO or vice president might talk about value-based care, but the board of the organization might not be talking about it. That permeates down to physicians practicing. That’s a big one. Aside from that, getting more into the technology, people are underestimating the time and resources it takes to connect all of their data with disparate organizations. Sharing information is really important and really hard to do. Providers are stalling or not adapting fast enough, and that is part of the concern as well.
With this in mind, do you think the alternative payment model goals that HHS has put out there are too aggressive?
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