Seven of the nine are moving to a shared services model, while only two Pioneer ACO organizations have dropped out completely, so the news is perhaps less disquieting. It’s important to note the shared savings approach was not an option at the time those seven entered into the Pioneer experiment.
It’s not surprising that all 32 Pioneer participants performed well on quality and outcome measures – high performing health systems like those in the Pioneer program have track records of being able to improve on outcomes and processes of care measures as demonstrated by improvements that have been achieved in these areas since the IOM publication of “To Err is Human” and the IHI 100K lives campaign. It’s also not surprising that these improvements didn’t translate into reductions in the growth of spending for all of the participating organizations. Health systems don’t have established track records of being able to identify key drivers of growth in utilization and spending and implementing interventions to address these drivers. These are new capabilities that even many of the most sophisticated providers are just beginning to develop.
These results seem to indicate that healthcare systems may find it easier to manage quality improvement efforts than to manage financial risk. This is especially true when fee for services payment methods dominate.
The key is developing the capabilities to be able to identify those interventions that improve the process of care as well as slow the growth in spending. In a Medicare environment, this means better processes of care to avoid hospital-acquired infections, to reduce re-admissions, to improve coordination of care, and to better manage end of life care.
What are the most relevant measures driving performance?
- Patient safety
- Core measures for medical and surgical episodes
- Length of stay
- Patient satisfaction
- In-patient expenses
To be successful, ACOs cannot continue “business as usual”; using clinical quality data to improve care is a key for success. At Truven Health Analytics, we believe intelligent use of data to improve the health of populations and the lives of patients is core to the future of healthcare in the U.S.
Michael L. Taylor, MD FACP
Chief Medical Officer