It’s all about the patients

The people behind federally subsidized ACOs believe in the dream of better care

WASHINGTON - This past April, the federal government announced the names of 27 healthcare organizations nationwide that will be part of a brand new Medicare Shared Savings Program. If the doctors and other providers in one of the newly selected accountable care organizations (ACOs) are able to lower costs and improve care, they will reap financial rewards. Yet if you ask any of those involved, the money is not what excites them. It’s the opportunity to deliver better healthcare.

ACOs come in all shapes and sizes and have evolved in all sorts of ways. Many have more than a decade of experience in trying to drive change through self-designed ACO-like activity -  well before the federal government issued the ACO regulations and searched for participants for the new Shared Savings Program. The one thing they all seem to have in common is they have evolved to best serve their local communities. The people involved agree that though healthcare IT is not required to participate in the Shared Savings Program, it is nonetheless indispensable for rendering the program a success.

This does not mean that every physician participating in the ACOs has an electronic health record system in place. Far from it. Many doctors are still lagging in adoption and yet they have chosen to take part in their ACOs anyway. Therein lies the hard part, the executives of some of the ACOs say. Yet, they seem to be undaunted by the challenges ahead of them. They believe they are on the edge of some great changes, and it all will work itself out.

Arizona Connected Care

For leaders of Arizona Connected Care in Tucson, Ariz., it’s a privilege to pave the way for others, particularly since their type of healthcare system is typical of many communities across the country.
John Friend, an attorney and the executive director of Arizona Connected Care firmly believes the federal Shared Savings Program is one of the many changes that will revolutionize the U.S. healthcare system. Friend is also the associate general counselor and vice president of business development for Tucson Medical Center, the ACO’s only hospital, a 615-bed nonprofit.

“You have to begin by resetting the standards. ACOs are a part of that,” Friend says. “If large transformation is going to happen, it’s going to take local organizations taking local responsibility.”

Tucson Medical Center had been working on building relationships with its physicians and improving outcomes for the past four years as part of a way to gain more market-share, Friend says. When the time came, it was fairly easy to form an ACO. “We became an ACO by attaching the ACO acronym to our ongoing project,” he says.

Friend says without the federal Shared Savings Program, Tucson Medical Center would have continued its efforts to improve care and the patient experience, but it would not have been able to do as much.

Show me the IT

There are IT challenges with forming an ACO. Nobody knows that better than Michael Griffis, the lead chief information officer for Arizona Connected Care and Frank Marini, the chief information officer for Tucson Medical Center and Arizona Connected Care.

According to Griffis, all 230 physicians participating in the ACO are physician-owned practices of varying sizes, composed of mainly primary care physicians. Most of the groups are fairly small, with one practice containing more than 100 physicians. That large practice is one of three federally qualified health centers participating in the ACO.

Of the 11 practices participating, four do not have EHRs yet. Two of those four will have them shortly.
Tucson Medical Center is in a position to be a technological leader for the ACO. It is among the 1 percent of hospitals ranking a Stage 7 for the use of technology, the highest ranking available on HIMSS Analytics scale, Griffis says.

“We have a pretty good solid history of success at employing large-scale complex [IT] initiatives in the hospital,” Marini says of the efforts to wire the hospital. “But when we talk about the IT to support an ACO, especially with physicians all using different electronic health records, we’re finding the challenges are pretty significant.”

“The ACO requires independent practitioners to have to do things differently to become aligned and coordinated across the continuum of care,” Marini says. “Exchanging information is the fundamental challenge to achieving clinical integration. Health information exchange is one of our primary objectives.”

On top of workflow issues and cultural challenges surrounding EHR adoption, some of the practices aren’t even close to what would be required for an ACO, Griffis says. The ACO program has only just begun. There’s a lot of work left to do, just to get things in place. But Griffis and Marini are optimistic, and they believe the effort will be worth it. “When we make this work, it will be highly relevant and replicable for other communities like ours,” Griffis says.