AJMC's ACO Coalition Explores the New Rules of Patient Engagement

AJMC's ACO Coalition Explores the New Rules of Patient EngagementFOR IMMEDIATE RELEASEMay 4, 2015

SAN DIEGO, California—Getting patients to work with physicians, employers, and health plans to manage their health is critical to achieving the “triple aim” of better population health, improved patient satisfaction and reducing costs, but this will require a shift in thinking from stakeholders across the healthcare spectrum. This change also demands that health systems move beyond their traditional boundaries to reach hard-to-treat populations, according to speakers who took part in the third live meeting of the ACO and Emerging Healthcare Delivery Coalition.

Improving patient engagement, and the consequences of failing to do so, were themes of the meeting that took place April 30-May 1, 2015, at the historic Hotel del Coronado in San Diego, California. The Coalition is an initiative of The American Journal of Managed Care.

“How do we engage people in their own healthcare?” asked Coalition Chair Anthony Slonim, MD, DrPH, as he opened the meeting. Dr. Slonim, president and CEO of Renown Health in Reno, Nevada, set the tone for the speakers, panel discussions, and small-group workshops; and for networking time with fellow members.

Both the Affordable Care Act (ACA) and goals set by the Centers for Medicare and Medicaid Services (CMS) connect payment with healthcare quality. For providers who are part of ACOs, financial success—even practice survival—now means looking beyond what happens during the office visit or trip to the hospital to all the factors that contribute to population health. Important takeaways included:

· “Ninety-nine percent of health outcomes are not related to healthcare,” said Kyu Rhee, MD, MPP, vice president of Integrated Health Services for IBM Corporation. Factors such as diet, exercise, the environment, and socioeconomic status all contribute to health outcomes—and always have—but the rise of ACOs has brought them under the purview of healthcare systems.

· For years, Dr. Rhee said, rising healthcare costs have limited hiring and the size of raises. This has forced employers to become more engaged in the health of workers. Now that the ACA has defined what employers must pay, more costs are being shifted to workers.

· Many speakers discussed how reaching high cost, hard-to-treat patients requires partnerships with social service organizations and a willingness to meet basic needs. Howard C. Springer, administrative director of strategy for accountable care services for Swedish Medical Center in Seattle, offered an example: Efforts to get a mentally ill woman to exercise failed until her health team learned she wouldn’t go to swim class for lack of a bathing suit. So they bought her one.

· Technology offers many tools for patient engagement, including add-ons for electronic health records, apps for smart phones, and wearable technology. But use of technology must be folded into the normal workflow or it will fail, said Ira Klein, MD, MBA, FACP, senior medical director, National Accounts, Clinical Sales and Strategy at Aetna.

· Failure to engage patients, or to have provider contracts that address differences in patient populations, will lead to more disputes within ACOs. Mediation can offer a better way to resolve disputes between providers and the ACO. Patient engagement is so important that it could be the fourth part of a “quadruple aim,” said Leonard Fromer, MD, executive medical director, group practice forum and assistant clinical professor, Department of Family Medicine, University of California.

All agree that ACOs must address social and environmental factors that affect health, Coalition participants said quality metrics and reimbursement models have not caught up with this fact. After Springer presented a model for integrating behavioral health into primary care, Jennifer Lenz, assistant vice president, Quality Solutions Group, California, National Committee for Quality Assurance, acknowledged that getting quality metrics and CMS’ own reimbursement standards into alignment can be very difficult, and this lack of consistency can limit innovation.

Despite these challenges, ACOs are driving change, although it’s too early to declare any single new payment model superior to all others, said Suzanne F. Delbanco, PhD, executive director of Catalyst for Payment Reform. Things have come a long way since 1999, when the Institute of Medicine issued the groundbreaking report on the hospital safety crisis, To Err is Human. “No one wanted to believe it,” Dr. Delbanco said.

“It’s much more accepted today that quality does vary,” she said. “We know when we buy healthcare, we’re not getting the same healthcare every time we write a check.”

Unlike past attempts to overhaul healthcare, leaders in today’s payment reform movement seek improved health outcomes alongside efforts to rein in spending. For CPR, quality is an essential element. “Payment reform must have attention to quality, otherwise it’s just shifting costs around,” she said.

Upcoming events for the ACO Coalition, which now has 190 members, include web-based sessions on June 25, 2015, and September 24, 2015. The fall live meeting will be October 15-16, 2015, at Innisbrook Resort in Palm Harbor, Florida.

About the ACO Coalition

As ACOs and other emerging delivery and payment models evolve and move away from traditional fee-for-service system models toward cost-effective and value-based care, the need to understand how these models will evolve is critical to building long-term strategic solutions. The mission of the ACO Coalition is to bring together a diverse group of key stakeholders, including ACO providers and leaders, payers, IDNs, retail and specialty pharmacy, academia, national quality organizations, patient advocacy, employers and pharmaceutical manufacturers to work collaboratively to build value and improve the quality and overall outcomes of patient care. Coalition members share ideas and best practices through live meetings, Web-based interactive sessions and conference calls. Distinguishing features are the Coalition’s access to leading experts and its small workshops that allow creative problem-solving. To learn more, click here.

CONTACT: Nicole Beagin (609) 716-7777 x 131

nbeagin@ajmc.com

www.ajmc.com