Metamorphosis: Reinvention Towards Accountable Care

“If you can’t beat ‘em, join them” goes the old adage, and hospitals today are taking a lesson-learned from the proverb. Given the new set of expectations encapsulated by ACO requirements, health care systems have been asking themselves “How do we effectively respond to the ACO process?” Murmurs from the owner side of our practice indicate that many hospitals believe the answer lies in collaboration.                    

Across the board, the Wayne O’Neill & Associates (WOA) team is observing a flock towards informal networks; independent hospitals are creating light alliances with other local providers in order to meet new ACO challenges and enjoy the benefits of a larger system. Examples like the Banner/MD Anderson collaboration or the UT Southwestern/Texas Health Resources synergy are proving that this joint approach can be successful. Healthcare executives connected to the WOA practice have conveyed that they are keeping their eyes on three main objectives: connecting with a broader number of payers, efficient patient care and improved outcomes, and cost sharing relative to expanding infrastructure and delivering care. Added benefits to the cross-leveraging of systems includes health information exchange, physician exchange, and delivering at a lower price.

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How are such agreements structured? While there is no official rule guiding this recent morph into informal networks, most of the successful attempts WOA has seen are shaped around written documents that highlight the specific understanding between all participating parties around key issues. For example, if they key issue is expanded infrastructure, then joint budgets and goals must be defined. But who is going to enforce these promises? At this time, no one really. As popularity of these collaborative networks garners more participants, there may be oversight bodies that come into play; but currently these structures rely mostly on allegiance and general legal agreements. Reprimand for not following through on a promise would be an ousting from the group and its retained benefits. There are various themes for integration, but regardless of the chosen structure, managing expectations and keeping all actions above-board are critical.

Internal issues such as teamwork, capital investment and distribution of resources also have to be worked out. Relationships with physicians is another area that has to be fine-tuned, but luckily the recent trend in physician relationships is a much more flexible and team-oriented demeanor.  Attributes such as this are imperative for delivering reliable care that is uninterrupted as these transformations occur.

Another issue on the forefront is the shift between volume-based and value-based reimbursement models; as facilities and infrastructure become more efficiently used, what cash flow model would make the most sense? From the evolving perspective of the WOA practice, the natural shift to a different model may be impending as the momentum of new health care realities catapults forward.

Today’s ACO environment has certainly presented a new set of challenges for healthcare providers, but amidst these challenges has emerged an opportunity to re-shape and re-define the structure of a market that, perhaps, has been a touch behind in the evolving economic landscape. Though it may seem like the Wild West at the moment, hospitals are striving to serve more persons with better care through partnerships, thus allowing them to compete while still retaining an intrinsic amount of autonomy. Reinvention through collaboration may be just a first step in the rodeo of accountable care, but with each endeavor, the new order of healthcare can be won.