9 'Cs' lead to accountable care

Lumeris CMIO puts forth steps to population management
By Jeff Rowe
10:04 AM
accountable care

There are buzz phrases, and then there are buzz phrases.  And if there’s one phrase that has permeated the healthcare sector more thoroughly than all the others, it’s probably “accountable care.” But what exactly does it mean?  Or, more to the point for healthcare providers, how do you know when you’re actually providing it?

There are, of course, numerous reasons why providers are grappling with that question, not least of which is the extent to which they’re demonstrably accountable is increasingly going to impact the extent to which they get paid.

[See also: IDC launches ACO roadmap.]

Deborah Zimmerman, MD, CMIO at Lumeris, says one of the questions that the operations, technology and services solutions company has recently been focusing on is, “What are those characteristics that a physician needs to have in order to deliver accountable care?”

As it turns out, at least in Lumeris’ eyes, there are nine, five of which directly concern the patient and four that are focused more on providers.  What they boil down to are steps that will transition a physician into the world of providing care via population management. Each step begins with a C.

C1:  Contact - “If you don’t see a patient,” Zimmerman said, “you can’t manage them,” adding that studies show that costs are lowered when providers are more proactive in engaging patients rather than waiting for patients to come to them.  “The care is simply better,” she said.

C2:  Comprehensive care - According to Zimmerman, accountable physicians aim “to take care of a larger spectrum of patients’ needs,” reserving the call to specialists for when symptoms or conditions are truly unusual.

C3:  Continuous, longitudinal, person-centered care -  Accountable physicians work with patients to reach considered decisions on care.  They engage and get to know their families, take into account their priorities and, ultimately, develop personalized care plans which lead to better health outcomes and lower costs.

C4:  Coordinated care - This “C”, Zimmerman said, looks across the care continuum and revolves around providers asking, for example, “How do I manage the (patient’s) transition from hospital to home?”  or, “How do I coordinate care between multiple specialists?”  Included in this “C” are reconciling medications and making sure home health specialists and social workers are part of the patient’s health plan.

C5:  Credibility and trust - While Zimmerman attributed the origin of the first four C’s to the Institute of Medicine in a report produced back in 1988, the fifth “C” is a Lumeris original and revolves around physicians gaining a patient’s trust by recognizing that how, and how much, they interact with their patients goes a long way toward building a relationship with them and gaining their trust.

“It might involve conversation around a specialist’s care,” she said, “or talking about advanced directives.”  In the end, the goal is to have the physician seen as a trusted adviser.

[See also: eHealth Initiative releases recommendations for accountable care.]

“Our experience has been that it isn’t intuitive to a physician how to manage a population,” Zimmerman said of the nine C’s project.  But as care outcomes are tied ever more closely to provider compensation, the need for ways to make qualitative assessments is only going to grow.

And, of course, the patient side of the care is only part of the necessary equation. 

Next up in Part 2 is the business end.