Financial and Clinical Integration of Accountable Care Organizations
Stephen M. Shortell, PhD, MPH, MBABlue Cross of California Distinguished Professor of
Health Policy and ManagementDean Emeritus, School of Public Health
Director, Center for Healthcare Organizational and Innovation Research (CHOIR)
University of California-Berkeley
Berkeley ACO WorkshopMay 8, 2015
What Are We Trying to Do?
Reaching for the Triple Aim
Improved quality and overall patient
experience
Constrained
costs
Improved population
health
What Will it Take?
Performance measurement
Incentives Capabilities
VALUE
Quality + ExperienceCost
Fundamental Changes in How Care is Paid for and Delivered
Pooling and management of assets under various organizational and governance models:
• Horizontal acquisitions and mergers
• Vertical acquisitions and mergers
• Virtual contractual arrangements and alliances
• Joint ventures
What Is Meant by Financial Integration?
The extent to which services provided to patients are coordinated across activities, conditions, providers and settings over time so as to maximize the value of care delivered.
What Is Meant by Clinical Integration?
What organizational forms can create clinically integrated care?
Key Question
ACO Participation in Physician Performance Management/Accountability, Percent within
Cluster Who Participate
Source: Shortell S.M., F. Wu, V.A. Lewis, C.H. Colla and E. Fisher. “A Taxonomy of Accountable Care Organizations for Policy and Practice.” Health Services Research., online, September 16, 2014. DOI: 10.111/1475-6773.12234.
Schematic overview of the Accountable Care Organization (ACO) Evaluation Logic Model
Source: Fisher, E. S., Shortell, S. M., Kreindler, S. A., Van Citters, A. D., & Larson, B. K. (2012). A framework for evaluating the formation, implementation, and performance of accountable care organizations. Health Affairs, 31(11), 2368-2378.
Six Key Success Factors for ACOs
• Size/scale
• Care management
• Electronic health record functionality
• Effective partnerships
• Patient/family engagement
• Measurement standardization and transparency
Source: Accountable Care Organizations: Promise and Performance.Berkeley Forum, February 2015.
What Our Panelists Will Cover• Jerry Kominski CMS Quality Performance
Measurement and Balancing Clinical and Financial Integration
• Jill Yegian Four Case Studies
• Bruce Bodaken ACO Sustainability
• Ken Kizer Clinical Integration Functionality and St. Luke’s Antitrust Case
• John Weigand ACO Antitrust Analysis
• Loren Baker Financial Incentive Alignment
Thank YouQUESTIONS/DISCUSSION
http://choir.berkeley.edu/
