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Accountable Care Organizations |
Laying Groundwork For Accountable Care with Pay for Performance
Client Profile: PHO associated with a major New England tertiary care teaching hospital
Project Type: Healthcare Strategic Planning
Challenge: To help the PHO reach a new market by bringing its varied constituents (employed faculty, community physicians, hospital management) together around offerings that would be attractive to the community’s several large self-insured employers.
DGA Solution and Results: DGA facilitated a strategic planning process culminating in facilitation of a retreat. We presented options and analysis to support decision-making. The PHO’s multiple constituents were emboldened to contract directly with self-insured employers using pay-for-performance contracts. These pay for performance tools are also integral to the PHO’s developing accountable care organization (ACO). This innovative strategy offers these employers value through a coordinated healthcare delivery system. The PHO, by becoming a preferred option for large employers, established a strong market position.
Creating Accountability and Building PHO Revenues with Clinical Integration
Client Profile: PHO associated with a tertiary care teaching hospital
Project Type: Healthcare Strategic Planning, Payer Contracting
Challenge: To help a successful PHO adjust to changes in regulations and market conditions by adopting clinical integration and expanding pay-for-performance.
DGA Solution and Results: DGA led strategic planning processes developing new strategies to replace the original contracting focus of the organization. The new strategies included an extensive clinical integration effort and significantly expanded pay-for-performance based on evidence-based clinical protocols and other quality initiatives. DGA also assisted the PHO to enhance its disease management program and develop an electronic medical record strategy. An information technology platform ties these efforts together, reducing fragmentation and increasing efficiency.
The new strategies provide value to large payers in addition to the smaller payers that had previously been served by the PHO. This new client base significantly increased PHO revenue based on the true value of the services it was in a unique position to provide. The implementation of evidence based protocols and pay for performance provided the foundation for this PHO to become an accountable care organization (ACO).
Developing Custom Tools for Case Management
Client Profile: Physician-hospital organization affiliated with a major health system
Project Type: Healthcare Business Intelligence
Challenge: Create a tool to structure and track the recording of information gathered during unstructured telephone conversations between “coaches” and patients in a disease management program. Data from these phone interviews was used in quantifying the effectiveness of the programs, so it had to be maintained in an organized form. The coaches needed a system that would allow rapid navigation to different pages on which they could record health status data during the conversation with the participants. They also needed to track whether critical questions had been answered during the call, and to navigate easily to unanswered questions.
DGA Solution and Results: Through interviews with the coaching managers and staff we identified required features for the tracking and recording system. We developed a series of prototypes to present our interpretation of the design concepts to the client’s staff. Through several iterations of rapid prototyping, we developed a clear definition of the system requirements and categorized features by phasing priority.
As components were developed, we previewed them with the client’s disease management staff, and worked with the client’s IT staff to integrate the database with others maintained by the IT staff.
Implementation of the system resulted in a 40% increase in department productivity compared with the previous paper-based system, according to the department’s manager. The system has been extended to accommodate additional diseases, and is currently being used to generate annual reports on the effectiveness of the clinical programs. This provider-based case management program is a key component of the organization’s developing accountable care organization (ACO).
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