Change is difficult. Yet, we’re in the midst of the most significant change in healthcare since the introduction of Medicare in the 1960s.
There’s significant controversy, operational mistakes and misinformation about these changes. This shouldn’t be surprising, as many parts of the healthcare system (hospitals, specialty physicians, skilled nursing facilities, etc.) must change to improve the quality of care and keep up with political pressures.
Let’s take a quick look at a couple of examples
Take CMS’s Pioneer ACO Model. One of the organizations that dropped out of the program did so for several reasons. But the one reason that stood out in my mind was the lack of ability to engage independent physicians in changing care because there was a lack of economic alignment.
Transitioning from a fee-for-service industry to a value-based industry is difficult work and requires many coordinated changes at once. That organization learned from its efforts and is changing its approach to become more successful in the next round of its population health efforts. Learning and improving both the model and execution are both a part of the change process.
Early results from CMS ACOs are promising. But we’re only at the beginning of this transformation. And because some have been more successful than others, this doesn’t mean we should shut down these programs.
Instead, we need to find ways to make them better by building on what is working.
Many of the early adopters of the reform model have seen patient’s health status improve, quality results improve and costs decrease. For example, all of the 32 original Pioneer program participants saw their quality scores improve.
One of the most successful Pioneers from a cost perspective in the first year was Montefiore Medical Center in the Bronx. They experienced a shared savings payment of $14 million, primarily as a result of a 10% hospital admission rate of the 20,000 Pioneer participants.
In Paducah, Kentucky, Jackson Purchase Medical Associates (an 18-member primary care physician group) had similar success in participating in the CMS Medicare Shared Savings Program (MSSP) Advanced Payment Model. They experienced a 20% reduction of hospital admissions for the 5,600 Medicare beneficiaries participating in their MSSP.
On the commercial health plan side, the changes are also beginning to occur at a more rapid pace. The number of provider-sponsored health plans is growing again (by an estimated 20% over a 3-year time period). And several of the major private national health plans have set targets in 2014 to expand the number of accountable care arrangements with delivery systems (such as Cigna, Aetna and Humana).
This growth is significant when you consider the first accountable care models were initiated in 2005 and implemented in 2006 by Mark McClellan (director of CMS under President Bush) through the Physician Group Practice Demonstration project. These first 10 ACOs helped the design of the programs today.
The journey has begun to our new healthcare system that will improve health and quality, and bend the cost curve. It’s a complex and long journey that will require adjustments as we learn of the unintended consequences and from our operational experiences.
Let’s be patient and understanding as we move together to this new world of health.