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What Does It Mean To Be Accountable?

November 23, 2011
by Mark Hagland
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As healthcare moves forward, provider leaders need to reassess their strategies
Mark Hagland
Mark Hagland

Just as this issue was going into production, the Centers for Medicare and Medicaid Services (CMS) released the final rule on accountable care organizations (ACOs) for the shared-savings program under Medicare. That program, one of two under healthcare reform for which participation will be optional, is actually one of five major healthcare reform-driven programs (the other three being mandatory) now being launched under Medicare. To say that the world is changing quickly for healthcare providers would be to express an extreme understatement.

Indeed, taken together, the three mandatory programs (healthcare-acquired conditions reduction, readmissions reduction, and value-based purchasing), and the two voluntary programs (ACOs and bundled payments) could reshape how care is delivered in the next decade. Fundamentally, purchasers and payers are saying, that through healthcare reform, the old ways of delivering patient care, and charging for it, are simply not going to work anymore-that providers must begin to provide concrete, documentable value.

And what is value? Ask 10 people and you'll get 10 different answers. But fundamentally, value involves some combination of quality, price, and service. Let's face it: the reimbursement incentives that have prevailed until recently have not promoted real value in the provision of healthcare delivery. Nor have any but the most pioneering patient care organizations pushed ahead in that area in spite of the lack of incentives for change.

Yet change is now in the offing; with the passage of comprehensive federal healthcare reform earlier last year, the landscape of healthcare delivery is set to undergo unprecedented change.

And what will the new healthcare look like? To find out, you might want to ask Michael Schrift, M.D., Debbie Pehler, Don Stumpp, Tomas Gregorio, or Steven Riney (see this month's cover story, beginning on p. 8); all of those healthcare leaders are pushing forward in the trenches, reengineering their care delivery in order to succeed under various aspects of healthcare reform, as well as under the meaningful use process under HITECH. And what are these leaders learning? Four things, fundamentally, I believe.

First, the organizations now making serious progress in reworking patient care delivery are moving forward under a banner of patient safety, care quality, patient satisfaction, performance improvement, or some combination of all of those elements, and are resolving all issues with patient-centric focus.

Second, the senior leaders of these organizations have been, and continue to be, willing to invest professional risk at a personal level in order to push their organizations forward. As everyone knows, healthcare organizations are mostly big, complex, often intensely political, entities; and without intense personal-professional commitment, it is generally impossible to move forward in any meaningful way.

Third, every one of these organizations is investing considerable time, effort, and money in performance improvement methodologies of all kinds, using lean, Six Sigma, Toyota Production System, and other techniques, to drill down multiple levels in order to reengineer care delivery processes. None of this work is easy, or else it would have been done long ago. But organizations like Allina, American Health Network, and Methodist Medical Center of Peoria, are proving that such change is indeed possible.

And fourth, not surprisingly, these healthcare leaders are leveraging clinical information technology, business intelligence, analytics, and other tools, in highly effective ways. The hard work being put into creating change could never bear fruit, let alone be sustained, without the intelligent use of the best IT tools available. In short, look towards where the pioneers are headed to know where things are going; and don't doubt for a moment that the new accountability in healthcare is here now on all of our doorsteps.

Mark Hagland, Editor-in-Chief Healthcare Informatics 2011 December;28(12):06

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