Collaborative Care Before Accountable Care: Achieving Low-Cost, High-Quality Care Through a Regional Collaborative in Florida
Published Online: December 12, 2013
Kavita K. Patel, MD; Alex Morin, MS; Rory Thompson, MS; David Guzick, MD, PhD; Tim Goldfarb; Wayne Jenkins, MD, MBA; Catherine Matthias, MBA
In this era of healthcare reform which is focused on cost containment and quality improvement, health systems are struggling to provide the right balance between quality and cost-efficient services. At the same time, advancements in biomedical knowledge and technological innovation are changing standards for the composition and volume of healthcare that can and should be delivered.1 As such, healthcare providers are working to develop alternative delivery and financing models that enable the provision of high-quality, high-value patient care.
Accountable care organizations (ACOs) hold promise as a model for the financing and delivery of high-value care.2 Since the passage of the Affordable Care Act, there has been a dramatic increase in ACO activity. In a comprehensive report that canvassed media releases, reports, and private payer activities, over 164 ACO entities were identified across the country.3 These entities include those that are actively bearing risk and coordinating care, and those that are still implementing such programs. Additionally, the Centers for Medicare & Medicaid services (CMS) recently announced that 27 entities covering 375,000 beneficiaries in 18 states had been selected to form ACOs under the Medicare Shared Savings Program (MSSP).4 The MSSP ACOs will add to the 32 organizations participating in CMS’ Pioneer ACO Program, which involves a more aggressive payment model and is designed for healthcare organizations and providers that are already experienced in coordinating care for patients across care settings.5 Together with ACOs in the private sector, these Medicare programs put the national total of operating or planned ACOs at well over 200.
However, many organizations are not yet prepared to pursue a full ACO contract with a payer. Moreover, there is no consensus on the optimum design or development path for an ACO. Many provider organizations are looking for ways to enhance their ability not only to deliver high-quality, low-cost clinical care, but also to streamline their many non-clinical lines of operation as a stepping- stone to an ACO, piloting and testing critical competencies first. Thus, providers are looking for innovative intermediate steps that can begin to achieve some of the aims of an ACO: better care for patients, at a lower cost.6 Many are looking for a strategic approach to begin integrating clinical and operational processes aimed at saving on cost and improving the care patients receive. Depending on their particular circumstances, these strategic approaches might involve creative partnerships between entities who realize that patient care could benefit from the steps that lead to accountable care.
The University of Florida Health Science Center and Shands Teaching Hospital and Clinics, Inc, (University of Florida and Shands) has taken a unique and innovative approach to addressing the increasingly complex needs of patients while being conscious of cost constraints: a regional collaborative with Orlando Health. This collaborative leverages each organization’s comparative advantage in the delivery of a number of clinical services and combines efforts in some non-clinical operations. This paper describes the phased approach of the 2 organizations in achieving efficiencies and cost savings. First, we discuss a series of clinical and health services (phase 1) that University of Florida and Shands and Orlando Health have jointly developed over the past 12 months which allow the organizations to share resources in order to offer a comprehensive range of clinical services at the lowest cost of the highest quality. Second, we discuss the University of Florida and Shands and Orlando Health Clinical Integration Network (phase 2), governed by both University of Florida and Shands and Orlando Health executives, which and deepens the collaborative efforts of the 2 organizations.
The result is a unique regional collaborative between 2 contiguous, non-competitive health systems that will serve as the foundation for the development of a “regional accountable care organization” (phase 3), first leveraging clinical core competencies of each organization, then moving to a more integrated model that includes operational and governance integration. This collaborative has allowed both organizations to offer better care, in a leaner, more efficient fashion. Moreover, the organizations’ continued integration plans make possible even greater cost savings and quality improvements by combining the inherent advantages of an academic medical center with a non-academic, non-profit organization.
An Opportunity for Collaboration
The University of Florida Academic Health Center comprises the research institutes and professional schools of the University of Florida and the Shands Teaching Hospital and Clinics, Inc. Known collectively as University of Florida and Shands, it is a $2.7 billion organization under the governance of the University of Florida. University of Florida and Shands operates across 2 campuses—Gainesville and Jacksonville, Florida. Like many academic medical centers, University of Florida and Shands serves a disproportionately impoverished population, with over one-third of their payer mix coming from Medicaid, as well as an additional 9% uninsured.
Its partner, Orlando Health Inc, is an approximately $2 billion not-for-profit corporation, with 1738 licensed beds in 6 hospitals, and is one of Florida’s most comprehensive medical systems, offering a wide range of tertiary and secondary healthcare services to approximately 1.8 million residents of Orange, Seminole, and Osceola Counties in Central Florida, its primary service area. Specialized treatment includes medicine, surgery, cardiology, oncology, pediatrics, orthopedics, obstetrics, and emergency care.
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