One of the not-often-enough-examined truisms of the U.S. healthcare industry has until recently been the notion that when it comes to innovation, one must automatically look to a very limited group of healthcare markets for insight: markets like Boston and other Massachusetts communities, Minneapolis-St. Paul, Cleveland, Cincinnati, Northern California, the state of Utah. These are advanced markets in which consolidation among payers, providers, or both, has helped to support and facilitate innovations of a variety of kinds.
But the reality is that, in mid-2014, innovation is springing up everywhere, including in places that might previously have been considered “unexpected.” A good example is middle Tennessee. As revealed in our July-August cover story, as well as in an in-depth interview with Jason Dinger, the president and CEO of Mission Point Health Partners, the Nashville-based organization created by the St. Louis-based Ascension Health in order to create an accountable care organization in Tennessee.
The leaders at Ascension Health have chosen to organize Mission Point Health Partners as a Medicare Shared Savings Program (MSSP) ACO, in order to care for more than 100,000 members across middle Tennessee. As I noted in the article carrying the interview with Mr. Dinger, the focus there has been ramping up quickly around data analytics to identify the accountable care organization (ACO) members in need of the most intensive medical interventions and care coordination. As I noted, they are working with The Advisory Board Company to perform care management and to do extensive data analytics around their population.
Importantly, Dinger and his colleagues believe that there is no reason they should not plunge headlong into the same kind of work that other patient care organizations are plunging into, in the new healthcare; and that is very significant, as accountable care work, in the broadest sense, begins to spread broadly across the U.S. healthcare system.
And what are Dinger and his colleagues learning? Pretty much what ACO leaders in every type of U.S. healthcare market are learning. As Dinger told me, “I think the hardest thing is really getting everything to work in concert with every other thing. One of the real challenges of our healthcare system is just how fractured it is,” he emphasized to me. “So as an accountable care organization, your sole mission is to reduce gaps in care and improve outcomes, but you’re trying to do that in a system that is essentially fractured, so getting everyone to work in concert is the hardest thing to do.”
And when it comes to data, information, and analytics topics, the same applies as well. As in other ACO organizations in other healthcare markets, Dinger and his colleagues are finding that patient/member identification and attribution remain huge challenges, as does the challenge of marrying clinical and claims data.
With regard to that, Dinger told me, “I think that we feel good about where we are; on the clinical and claims data, I think the next frontier is really non-clinical data, in order to be able to intervene to help patients, based on data that is not at all clinical, but that can provide great insight into how to care-manage patients/members. For example, does a patient own a car? What is that patient’s transportation capability? Because what you find,” he said, “is that a primary care physician might refer a patient to a specialist who’s nowhere near a bus route, and the simple fact of the inability to access transportation can strongly impact the clinical outcomes involved in a situation.”
With regard to all the challenges that Jason Dinger and his colleagues have been tackling lately, it’s very heartening to know that the folks at Mission Point Health Partners are becoming less “unusual” every day, as healthcare leaders like them, with vision and a sense of mission around the new healthcare, make the strategic decision to push ahead with accountable care initiatives, both within the Medicare program and in the private health insurance sector. It will be exciting to see all the new flowers blooming in all the new places, in the next few years—and to be able to report on an ever-wider group of pioneering organizations all across the United States, and not just from all the “usual places.”