Monday, May 10, 2010

Fragmented Systems Don't Mean Fragmented Care: What Accountable Care Organizations Can Learn From Employer-Purchasers

When the Commonwealth Fund has nice things to say about "disease management," the Disease Management Care Blog pays attention. Check out this Purchasing High Performance newsletter interview with Jerry Burgess of an employer-based health care coalition called Healthcare 21 and Chris McSwain of Whirlpool Corporation.

Burgess and McSwain agree that it's possible for an insurer/employer to have multiple vendors including disease management firms in a well functioning coordinated mix of health care services.

The DMCB likes this article, not only because it speaks to the merits of the Unified Field Theory approach to care management, but because it also describes a template for leaders of budding Accountable Care Organizations to consider. Like employer-purchasers described in this Commonwealth Fund article, ACOs are also going to find that having a hospital and a physician network are not enough. They'll need the help of service vendors to help manage their populations' clinical outcomes and costs.

Here's how to do it:

1) Get the principals in a room once a year to make sure everyone understands the need to work with each other (patient referrals, data transfer are two examples),

2) Manage the vendors like a "supply chain" that exists to improve health and productivity,

3) Don't get too cozy with the vendors,

4) Demand objective measurement and reward good performance in outcomes based contracting,

5) Find vendors that can be in it for the long term; three year contracts should not be unusual.

As an aside, the DMCB will point out that disease management organizations (DMOs) have a track record of performance when it comes to coordinating services with other entities, working in supply chain mode, being all business, emphasizing measurement and contracting over multiple years. They'll get it. The challenge for ACOs will be to get the other providers, hospitals, behavioral health suppliers and pharmacy managers to work together.

In fact, the DMCB wonders if helping ACOs to coordinate the other vendors may turn out to be a future role of DMOs. We'll see.

Hat Tip to a certain Maven for the alert about this article. You Know Who You Are.

(There's lots more on Accountable Care Organizations here)

No comments: