Accoutable Care Alliance Marks One Year Anniversary (07.21.11)

One year ago this month, The Nebraska Medical Center and Methodist Health System announced the joint creation of an Accountable Care Organization (ACO), the first in the nation by two competing hospitals.

Their ACO named the Accountable Care Alliance (ACA) is designed to bring providers, payers, and eventually patients together in a common platform where incentives are aligned to reward higher-quality, cost-efficient care.

The ACA 12 member governing board includes five physicians from each health system along with each hospital’s chief financial officer.  
Dennis Goeschel, MD, ACA board chairman and medical director of ambulatory services for UNMC Physicians, says the two systems have worked diligently to overcome challenges that an ACO partnership brings.

“I think the greatest accomplishment this past year has been to bring together physician and non-physician leadership from two separate, competing hospital systems to jointly begin a large scale process of improving the quality of care we provide to our patients.”

A goal of the alliance has been to develop common clinical protocols between the two health systems to improve quality of care and to reduce waste.

“Endorsement of evidence-based medical interventions by local experts and opinion leaders is the key to standardizing care,” said Tony Piskac, MD, chairman of the ACA medical management committee and vice president of quality for Methodist Health System.  “We are blessed to have leaders in our respective medical staffs that are willing to lend their time and intelligence to the design of these systems.”

The ACA has been focusing on clinical areas with high volume, high variation and high cost Diagnosis Related Groups (DRGs).
One of the first quality improvement projects was to standardize care for total joint procedures led by James Canedy, MD, ACA board member and orthopedic surgeon at The Nebraska Medical Center.  

“All physicians are motivated to improve outcomes for their patients,” said Dr. Canedy. “Offering outcomes data, best practices and standardization should result in decreased risk and cost."

Another major focus has been on reducing 30-day hospital readmissions.  The ACA has established procedures to review readmission processes and develop best practices.  Some of those best practices include a new discharge plan for those at risk for readmission and a care transition plan that has been implemented for patients who are discharged to nursing home care or a skilled nursing facility.

“The nurse practitioner rounding in the skilled nursing facility provides frequent assessment and treatment of symptoms and complications,” said Rebecca Reilly, MD, medical director of the geriatric assessment center at Nebraska Methodist Hospital.  “This follow-up care is helping to prevent a relapse of the patient’s condition requiring readmission back to the hospital.”

Dr. Goeschel says the medical center and Methodist made the right decision to set up an alliance as early as they did. "What is clear is that we are going to be reimbursed differently in the future, and I personally think fee-for-service will decrease or disappear, particularly in large, urban areas. Payment will be based in part on how well we provide and report quality, and we will see more bundled payments, payments for episodic care and capitation," he says. "I don't see how we can avoid these changes, but we can do something about them and try to get ourselves prepared to respond to them. Physicians and hospitals are going to have to partner together and take joint responsibility for the care of their patients.”