What can ACOs learn from Europe?

Accountable care demands continuity of care
By Mike Miliard
09:23 AM
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Earlier this spring at HIMSS15 in Chicago, HIMSS Analytics Executive Vice President John Hoyt led an education session about the Continuity of Care Maturity Model he and his colleagues helped devise.

During the session, the audience was asked how many hailed from outside the U.S. "Two out of three hands went up," says Hoyt.

Accountable care and care continuity are not the same things, of course. But they have a whole lot in common. And the former pretty much depends on the latter.

[See also: ACOs hamstrung by poor data exchange]

"The rest of the world," says Hoyt, is "more into continuity of care than the Americans are."

Launched in 2014, the eight-stage CCMM puts a focus on interoperability, health information exchange, patient engagement and clinical and business intelligence – all necessary components of care coordination for population health.

ACOs and other value-based initiatives have been pursuing these goals in earnest these past few years. But in many parts of Europe and elsewhere in the world, care continuity has been the byword for sometime.

In single-payer Europe (or, in the case of the Netherlands sextuple-payer: "there are six insurance companies that all have to provide the same level of benefits, like six companies offering Medicare"), "they're very attuned to continuity of care," he says. "They're more holistic in their view of healthcare than we are."

In the U.S., of course, attitudes and incentives are very, very different.

"We have so much of a competitive environment in our healthcare that it's disjointed," says Hoyt. "That's why we built this CCMM. Because that really is the next big thing."

The model was not explicitly developed with accountable care in mind. But driving efficiencies within big health systems and across their spheres of influence was a big motivator – as was a vision for a truly global strategy for coordination. In fact, says Hoyt, much of the input as it was created came from European stakeholders, from Germany, Italy, Scandinavia and the Netherlands.

I ask Hoyt what Europeans think of America's fairly recent – and sometimes halting – pursuit of the ACO model. Having embraced value-based ethos for decades, do they think it's … cute?

[See also: Europe sets goal of EHR interoperability by 2015]

"Yeah," he says. Hoyt recalls a recent conversation with a public health official from Sweden: "You Americans are too focused on hospitals," he paraphrased. "They're a big cost center. You're focusing on something we don't want people to use, and you should focus on the bigger picture."

"She's right," says Hoyt. We need to shift our emphasis toward ambulatory care, just as they have in Europe. "They just have that as part of their culture: Sweden, Finland, Norway, Denmark, the Netherlands and maybe the NHS."

But European countries hardly have everything figured out. And in some respects the States' post-HITECH push these past few years has left us ahead of the game. "The truth is they still have gigantic holes in the electronic medical record in the acute care world. They lack a lot of cohesion inside the hospital because there are so many best-of-breed type hospitals. Like we were, before the late-'90s."

At the same time, says Hoyt, "you can criticize the fact that they're missing pieces in the hospital, but that which they have, they openly share, because they are very, very oriented to the whole continuum of care. They want people to get healthy, stay healthy, use services that are not expensive, stay out of hospitals."

So we have them beat on the technology side but they're much further along with the philosophical ethos of sharing. Sounds about right. But we're getting there on the latter point – if only because the Centers for Medicare & Medicaid Services, with its ambitious new goals for the transition to value-based care, is helping force the issue.