Beth Israel Deaconess Goes ACO; What Does That Mean?

Does “ACO” mean anything to you yet? Well if you want to do more than nod and smile the next time you’re around a lot of doctors, read the next couple of paragraphs.

Hospitals that plan to stay in business in Massachusetts are either creating or joining Accountable Care Organizations (ACOs). Today we have a new one of these large “all care under one umbrella” groups: The Beth Israel Deaconess Care Organization (BIDCO) includes the hospital, its physicians’ group and two affiliated hospitals. BIDCO is in talks with Cambridge Health Alliance, Signature Healthcare in Brockton and a few other organizations about joining.

Dr. Kevin Tabb, who runs the hospital (Beth Israel Deaconess Medical Center), says ACOs offer a new and better way to deliver and pay for care.

Dr. Kevin Tabb, chief of Beth Israel Deaconess Medical Center and co-chair of the new BIDCO

Dr. Kevin Tabb, chief of Beth Israel Deaconess Medical Center and co-chair of the new BIDCO

“For a very long time,” says Tabb, “we’ve taken care of sick patients, doing a good job while they’re here and not thinking about them a lot after they leave the hospital. That felt like a broken model.”

Now, says Tabb, “we’ll think about patients not only when they’re here at the hospital, but after they leave,” and when they are well. Why haven’t doctors and hospitals done this in the past? Tabb offers two reasons: Doctors and hospitals haven’t had the structure to do this and they weren’t paid for keeping people well. Thus the new world, built around the structure of an ACO and financed by a global payment.

If you’ve been seeing a doctor affiliated with Beth Israel, you might be wondering, how does this affect me? Dr. Stuart Rosenberg, who will co-chair BIDCO representing physicians, says “for the first time, we are able to really look at the patient and assess their health care needs no matter where that might be provided.” A doctor will no longer have to see a patient in her office to get paid for delivering care.

Dr. Stuart Rosenberg, co-chair of the new BIDCO

Dr. Stuart Rosenberg, co-chair of the new BIDCO

Under an ACO and a budget that lets doctors decide how to spend money on patients’ care, doctors are “developing care plans that are limited only by our imagination and the law,” says Rosenberg.

He illustrates with the example of Mrs. Jones, a patient with a chronic disease who isn’t taking her medication, is skipping doctor’s appointments and comes to the emergency room when her blood pressure or diabetes get out of control. BIDCO could send a nurse to visit Mrs. Jones, give her rides to appointments and follow-up with phone calls. And the amazing thing, says Rosenberg, is that we can “provide that personalized care and actually save money on top of it.”

Sounds pretty good, huh? But if you have private insurance or MassHealth, there may be a catch. Continue reading

Cartoon Solves Health Care Puzzler: What The Heck Is An ACO?

Ladies and gentlemen! Announcing a whole new film genre: Wonk Cinema!! And what we hope will be the first in a series of CommonHealth cartoons dedicated to helping people stay awake as they learn about important health care changes that affect their lives.

Our first topic: “What the heck is an Accountable Care Organization?” Five minutes, just five minutes, to unravel one of the great mysteries of the universe! Explain the inexplicable! Destultify the stultifying! Also, to cast much-needed light on a health care phenomenon that is sweeping the state and the country…

We’re taking requests for other topics so soporific and esoteric they can only be explained tolerably in a cartoon video. What should we do next? Tiered health insurance? Payment reform? Please lodge your suggestion in the Comments section below.

And deepest thanks to former Boston Globe health care reporter Jeffrey Krasner, now president of Krasner Health Strategies, for lending his deep knowledge and rapier wit to this project. Continue reading

More Scrutiny Of Accountable Care Organizations

Deep scrutiny and analysis of so-called Accountable Care Organizations, or ACO’s, continues with a new report in the current issue of Health Affairs.    It looks at how medical groups are responding to Blue Cross Blue Shield of Massachusetts’ version of this latest iteration of care delivery, which hinges on global payments and financial incentives for doctors to keep their patients healthy.

The report, by researchers led by Robert Mechanic, a senior fellow at the Heller School of Social Policy and Management at Brandeis University, focuses on the medical groups that are signed on to Blue Cross’s Alternative Quality Contracts. The findings underscore that changes are indeed underway.

For instance, the study finds that medical groups have introduced new information systems and processes to help primary care doctors improve their performance quality scores, and they’re implementing new referral services to steer patients toward lower-cost care when appropriate.

But the report also highlights some challenges, including one which seems pretty darned significant: When you keep people healthy and out of the hospital, you save money. However, you also cut in to hospital profits. Here’s how they put it in the report: Continue reading

Why ACOs Are Like Unicorns And TV Sets

No matter how much I hear about Accountable Care Organizations, a key feature of the coming wave of cost-containing health reform here and nationwide, I still feel vaguely confused about them. Last week, the federal government issued guidelines on ACOs, making the topic even hotter but not, for me, much clearer.

So I’m deeply grateful to the excellent reporters at Kaiser Health News for their clarifications — and particularly for their analogies. They’ve just put out a new guide on ACOs, including this:

ACOs have been compared to the elusive unicorn: everyone seems to know what it looks like, but no one has actually seen one. But the health care industry has already embarked on a frenzied quest to create them as quickly as possible. Today, after many delays and false starts, the Obama administration proposed guidelines on how ACOs will work.

Here is a brief guide to what we know about ACOs.

What is an accountable care organization?

An ACO is a network of doctors and hospitals that shares responsibility for providing care to patients. In the new law, an ACO would agree to manage all of the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years.

Think of it as buying a television, says Harold Miller, president and CEO of the Network for Regional Healthcare Improvement and executive director of the Center for Healthcare Quality & Payment Reform in Pittsburgh. A TV manufacturer like Sony may contract with many suppliers to build sets. Like Sony does for TVs, Miller says, an ACO would bring together the different component parts of care for the patient – primary care, specialists, hospitals, home health care, etc. – and ensure that all of the “parts work well together.”

The problem today, Miller says, is that patients are getting each part of their health care separately. “People want to buy individual circuit boards, not a whole TV,” he says. “If we can show them that the TV works better, maybe they’ll buy it,” rather than assembling a patchwork of services themselves.

Now that, I get! And here’s an extremely useful Kaiser Health News page with a whole bouquet of useful federal links on ACOs. Now we just need a Massachusetts equivalent — if anyone knows of one, please let us know.

For gluttons, there’s also the four-minute video with Jordan Rau of Kaiser Health News discussing the ACO guidelines. And there’s a delicious KHN/Washington Post piece today about how ACOs are creating a veritable gold rush for health care consultants.

Our ‘Reform 2011’ Forum Wants You! Presenting Guest Post #1: ‘HMO Deja-Vu’

Commenter Dennis Byron expects a back-room deal on health care reform right around the time the fireworks go off above the Hatch Shell.

Thanks to WBUR’s Martha Bebinger and an all-star team of guest posters, CommonHealth served a unique role documenting the debate that culminated in the passage of the landmark Massachusetts health overhaul of 2006. (The full archives are here.)

Now, Gov. Deval Patrick has just officially launched Health Reform II, and all the signs are pointing to 2011 as the year for the second great wave of health care reform here. Once again, CommonHealth aims to serve as a forum for the exchange of interesting and important thoughts on what should be done. To offer a submission or sound us out, please just hit the “Get in touch” button below. Warning: We must be merciless about keeping guest posts readable and user-friendly. The piece below is an example of how punchy writing and strong opinions can bring a potentially soporific subject to life.

Our guest poster: Dennis Byron is a researcher in enterprise software market statistics who has just started his own blog on Massachusetts health care statistics here. He’s an active commenter on CommonHealth who casts a gimlet eye on the results of health care reform so far, and I’m always grateful when he writes in because he has a spot-on detector that picks up when I’ve glossed over something or failed to ask the right skeptical questions. He describes himself as semi-retired and “clearly with too much time on his hands;” I hope that remains true enough for him to keep commenting.

Patrick’s Proposal: Too Soon To Tell But…

By Dennis Byron

The details of the latest of many Massachusetts health care reform efforts are still dribbling out. But the message is unclear. It’s either the beginnings of socialized medicine in the Bay State or it’s a moderate attempt to slightly tweak a world-class healthcare delivery system to make it better. In reality, it’s too soon to tell. It’s not just that you probably still have not read the actual 50-pages-plus of proposed legislation but, more important, the legislature is going to change it anyway just as it has changed a half-dozen or more “health care reform” efforts dating back to the 1970s. Last year alone the Great and General Court changed the “2006 reform” twice.

Commenter Dennis Byron (on a trip to Helsinki)

But if history is any indicator, get your two cents’ worth in now because the changes are going to be made in a back room on Beacon Hill and signed into law at 11:30 pm July 3rd.

My personal take is that both the current proposal and the 2006 effort are/were solutions looking for problems. The combination of the two is not going to change anything and might make things worse.

I admit that when I see propaganda, I assume I am getting a snow job. For example: Continue reading